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| Where the revenue leaks | Estimated / year |
|---|
How this estimate works
This calculator turns published, industry-standard revenue-cycle benchmarks into a practice-level estimate. It is deliberately conservative and transparent — the goal is a credible starting point for a conversation, not a precise audit.
The benchmarks behind it
- Initial denial rate ≈ 11.8% of claims (2024) and rising — Kodiak Solutions / HFMA and the Optum Denials Index.
- ≈ 84% of denials are potentially avoidable — Optum 2024 Revenue Cycle Denials Index (124M+ claims across 1,400+ hospitals).
- Net collection rate floor of 95% (97–99% optimal) — HFMA; anything below signals leakage.
- High-value services (imaging, surgical, specialty drugs) run 18–20% higher denial rates than routine visits — which is why the estimate is tiered by specialty.
Specialty tiers
Reputable per-subspecialty denial rates aren't published openly, so rather than invent precision we group specialties into three payer-scrutiny tiers and apply a defensible leakage range to each. High-value procedural specialties (cardiology, orthopedics, pain, GI, oncology, urology, interventional radiology) sit in the top tier; primary care and pediatrics in the lowest.
Sources
- Optum 2024 Revenue Cycle Denials Index
- HFMA MAP Keys — industry-standard revenue-cycle KPIs
- MGMA — practice denial benchmarks
- Kodiak Solutions — 2024 initial denial rate data