Interactive Tool

The Denial Cost Calculator.

Four inputs, five outputs, every assumption disclosed. Slide the numbers to match your practice and watch the ledger update.

Your inputs

Monthly claims submitted

Average claim value

Denial rate

Default 11.8%, the 2024 industry average initial denial rate.

% of denials your team currently works

Industry data: 50–65% of denials are never worked at all (MGMA).

Your ledger

Denied per month$17,700

Denied per year$212,400

Estimated recoverable (× 66%)^a$140,184

Annual in-house rework cost^b$14,160

Currently walking away from$84,110

This math is generic. Get YOUR number:

Methodology & assumptions

Monthly $ denied = monthly claims × average claim value × denial rate. Annual figure is 12× monthly.
a. Estimated recoverable applies the Advisory Board figure that roughly two-thirds (66%) of denied claims are recoverable.
b. In-house rework cost = denied claims per year × % worked × $25, the MGMA/HFMA industry-average cost to rework one denied claim. Real costs can exceed $100 per appeal.
“Currently walking away from” assumes denials your team works recover at the same 66% rate, so it equals estimated recoverable minus recovery from current effort. Your actual overturn rates vary by payer, denial reason, and documentation.

Illustrative estimate, not a guarantee of recovery.

Know your number before you sign anything.

The Recovery Audit is a $500 analysis, yours free, in writing, with an honest go/no-go. Limited slots each month.

Sources

a.Roughly two-thirds of denied claims are recoverable. Advisory Board
b.The average cost to rework a single denied claim is $25, and can run over $100 per appeal; some estimates range up to $118–$181. MGMA / HFMA / Change Healthcare industry reports