How This Calculator Works
The numbers used here are based on published industry data and healthcare billing research. Use these estimates as a starting point — your actual results depend on your payer mix, documentation quality, and claim types.
Annual Denied Claims
Formula: Monthly Volume × 12 months × Denial Rate
Example: 500 claims/month × 12 × 10% = 600 denied claims/year
Total Annual Denial Loss
Formula: Annual Denied Claims × Average Claim Value
Example: 600 denied claims × $250 avg = $150,000 lost to denials
Estimated Recovery (65% success rate)
Of denied claims that are appealable with proper documentation, approximately 65% are overturned on appeal — based on data from MGMA and CMS research. Not all denials are appealable (timely filing, patient responsibility, and some contractual denials have lower potential).
Service Fee (20% of recovered)
Most denial recovery services charge 15–25% of recovered revenue on a contingency basis. We use 20% as a mid-range estimate. Our service charges 15–25% based on volume — you keep 75–85% of everything recovered.
Industry Benchmarks
According to 2024–2025 data from the Medical Group Management Association (MGMA), the average denial rate across specialty practices is 10–15%, with primary care typically at 5–8%. Large hospital systems average 6–12%. Average claim values vary significantly: primary care ($120–$180), specialty ($200–$400), surgical ($400–$2,000+).