What your denials cost
Three numbers you already have, and you get the figure: how many denials a month, what working them costs at the published $57.23 each, and the billed value sitting in them. The three published rates are cited; everything else is arithmetic on what you typed, in your browser.
How much of that billed value a payer would actually pay is not something a published figure tells you: it depends on your contracts and on which denials are overturned. It is the size of the pile, not a recovery estimate.
Your figure is 0.8 percentage points below the published initial-denial rate of 11.81%. The question then is not the rate, it is what happens to the ones you do get — the cost above is the cost of working them, not of having them.
A queue of 132 denials a month? One AR seat works them for $1,700/month, flat. Book 20 minutes · Billing company? Add capacity
Where these three figures come from
- $57.23 to rework one denied claim — $57.23 per denied claim. Source
- Payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment — a figure about claims generally, so the calculator does not apply it to your denials — 90%. Source
- 11.81% initial denial rate — 11.81% of claims. Source
Those three are somebody else’s measurement, not ours — we have never counted a denial at any practice and will not present a figure as though we had. Everything else on this page is arithmetic on the numbers you typed, in your own browser. Nothing is stored.
The cheapest denial is the one that does not happen. Which ones to work first · the letter for the ones you appeal.
Why the number is worth having
“We have a lot of denials” is not something a practice can act on. It does not survive a partners’ meeting, it does not justify a hire, and it does not tell anybody which of the forty things on the list to do first. A figure does — and the practices that most need one are precisely the ones with nobody free to work it out.
The two halves matter differently. The cost of working denials is real money already being spent, usually by somebody whose actual job is something else. The value in the denials is money that can only be recovered if somebody gets to it — and it is lost quietly, because a claim that ages past the appeal window does not announce itself. How much of it a payer would actually pay, no published figure says. Neither number is an argument for us. They are an argument for somebody, and it is worth knowing the size of it before deciding who.
Questions
How much does it cost to rework a denied claim?
Premier’s published figure is $57.23 per denied claim in administrative cost to adjudicate, and the same work is frequently repeated — Premier reports roughly three rounds of review at 45 to 60 days each. That is the number this calculator multiplies by your own denial count. It is a published figure, cited on the page, and not a measurement of your practice.
What is a normal denial rate for a medical practice?
Kodiak Solutions’ published analysis puts the initial denial rate at 11.81% of claims. Treat it as a reference point rather than a target: the rate that matters for your money is what share of denied dollars you actually recover, and Kodiak’s own figure is that payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment.
Are denied claims recoverable?
Many are, if they are worked in time, but nobody has published a recovery rate on denied claims that this page could cite. Kodiak’s figure is that payers ultimately pay roughly 90% of claims generally, even while using an initial denial to slow payment; that is a statement about claims overall, not about denied ones, so the calculator does not apply it to your denials. The reason so many denials sit unworked is rarely that nobody knows how — it is that nobody has the hours, and a denial that ages past the appeal window or the filing limit stops being recoverable at all.
Does this calculator store my numbers?
No. There is no account, nothing is transmitted and nothing is saved. The arithmetic runs in your browser. Do not type patient information into it — it does not ask for any.
Working the denials needs hours, not cleverness
The figure above is only real if somebody works the queue. Send ninety days of aged AR and we will tell you, in writing, how much of it is actually recoverable and what it would take — before you pay us anything, and whether or not you ever do.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to info@softhomebpo.com and skip the form entirely. What happens to it.
The rest of the free tools
Next step
Working the denials needs hours, not cleverness
An AR and denials seat is $1,700 a month, full time, on your hours, inside your own system. Send an aged AR report first and see what we find before you pay anything.
Or write to ops@softhomeglobal.com