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 what share is recoverable. The three published rates are cited; everything else is arithmetic on what you typed, in your browser.
Your figure is 0.8% below the published initial-denial rate of 11.8%. 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.
Where these two figures come from
- $57.23 to rework one denied claim — $57.23 per denied claim. Source
- 90.0% of denied claims are eventually paid when they are worked — about 90%. Source
- 11.8% 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 recoverable half is money that is only lost if nobody gets to it — and it is lost quietly, because a claim that ages past the appeal window does not announce itself. 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 roughly 90% of denied claims are eventually paid when somebody works them.
Are denied claims recoverable?
Mostly, if they are worked. About 90% of initially denied claims are eventually paid according to the published figure cited on this page. The reason so many are not 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.
The recoverable half 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 ops@softhomeglobal.com and skip the form entirely. What happens to it.
The rest of the free tools
Next step
The recoverable half 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