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Where the money is actually going
Six places revenue leaves a practice, worked out from your own numbers. Every formula is shown so you can disagree with it — and there is no assumed recovery rate anywhere in it.
What your own figures imply is leaking
$40,557/month
$486,684 a year on these inputs
Where it goes, largest first
| Leak | A month | Share | Worked by |
|---|---|---|---|
| Slots lost to no-shows | $13,920 | 34% | Patient scheduling & recall |
| Denied claims never reworked | $7,047 | 17% | AR caller / denials |
| Denials caused at registration | $6,960 | 17% | Eligibility & benefits |
| Claims paid below the contracted rate | $5,220 | 13% | AR caller / denials |
| Aged AR passing the point of collection | $4,800 | 12% | AR caller / denials |
| Work done and never charged | $2,610 | 6% | Charge entry & claim submission |
The arithmetic, so you can check it
Slots lost to no-shows — $13,920 a month
1,200 scheduled × 8% no-show × $145
Capacity rather than a claim: the slot existed and produced nothing. Recoverable only by filling it, which is a scheduling job.
Denied claims never reworked — $7,047 a month
1,200 claims × 9% denied × 45% never reworked × $145
A denial that nobody opens is the cheapest money in the building to recover and the most commonly left. This is the figure most practices have never calculated.
Denials caused at registration — $6,960 a month
1,200 claims × 4% with an eligibility or registration defect × $145
Created at the front desk and discovered in billing. The cheapest category to remove entirely, because the fix happens before the visit.
Claims paid below the contracted rate — $5,220 a month
1,200 claims × $145 × 3% underpaid
The one nobody looks for. An underpaid claim closes on the remittance looking exactly like a paid one, so it appears on no ageing report and no denial report.
Aged AR passing the point of collection — $4,800 a month
$120,000 over 90 days × 4% ageing out per month
Not the whole over-90 bucket — the slice of it that crosses a filing or appeal deadline this month. Enter your own rate if you know it.
Work done and never charged — $2,610 a month
1,200 encounters × 1.5% never charged × $145
Encounters closed clinically with no charge attached. Invisible on every denial report, because there is no claim to deny.
The seats that would own your three largest leaks
- Patient scheduling & recall — $1,500 per seat per month
- AR caller / denials — $1,700 per seat per month
- Eligibility & benefits — $1,700 per seat per month
$4,900 a month against $40,557 a month of leakage on your own figures. That is a cost comparison, not a promise. How much of the leakage is actually recoverable depends on your payers, your contracts and how old it is, and anybody who tells you a percentage before looking at your ageing report is guessing.
What this number is and is not
It is: your own inputs multiplied out, with every formula shown above so you can disagree with any of them.
It is not: a projection of what we would collect, a recovery rate, or a payback period. We have no audited outcome data across a client base, so a figure like that would be a claim we could not stand behind — and every other calculator in this category produces one by applying a lift the vendor invented.
Why most practices have never seen this number
Each of these six leaks is measured by a different report, and two of them are measured by no report at all. Underpayments close on the remittance looking exactly like paid claims. Encounters never charged produce no claim, so they appear on nothing. A practice can run a clean denial report every week and still be losing more to those two than to everything the report shows.
The point of putting them on one page is not the total. It is the order — which of the six is biggest in your practice, because that is the only one worth starting on, and it differs by practice far more than people expect.
Questions
What is revenue leakage in medical billing?
Money a practice earned and did not collect, lost to something other than a payer refusing to pay. The six usual routes are denials nobody reworked, aged AR crossing a filing deadline, claims paid below the contracted rate, denials created at registration, work done and never charged, and slots lost to no-shows.
How much revenue does the average practice lose?
There is no honest single figure, and any calculator quoting one has invented it. It depends on claim volume, payer mix, denial rate and — most of all — whether anybody is assigned to each of those six queues. This tool multiplies out your own numbers rather than applying somebody else’s average to you.
Which leak should I fix first?
Almost always denials nobody reworked, because the money is already earned, already adjudicated and needs labour rather than a change to how the practice runs. Underpayments are usually second and are invisible on every standard report, because an underpaid claim closes looking exactly like a paid one.
Does this tell me what I would recover?
Deliberately not. It shows what your figures imply is leaking. How much is recoverable depends on your payers, your contracts and how old the balances are, and we have no audited outcome data across a client base — so a recovery percentage from us would be a claim we could not stand behind.
What does it cost to have somebody work these queues?
Seats are published per role, from $1,500 to $2,500 per seat per month, with a one-month minimum. The calculator names which seat owns each leak.
Next step
Twenty minutes and your ageing report
Enough to say which of the six is actually biggest in your practice, and whether a seat pays for itself against it.
Or write to ops@softhomeglobal.com