Calculator
Denial revenue-leak estimator
Most practices know their denial rate. Fewer know how many of those denials anyone touches again. This estimates the dollars left in the ones nobody works, per month and per year, from four numbers you already have.
Part of Remitwright's free medical billing calculators, each with its formula shown.
Results are worked out in your browser. Nothing is sent unless you submit a form.
Last reviewed by the Remitwright billing team. Editorial policy
Result
Dollars left in unworked denials
Enter the four figures and press Estimate.
per month left unworked
For comparison: MGMA's 2023 DataDive data showed a single-specialty aggregate rate of 8% for claims denied on first submission1. The AAFP measures denials by dollars and calls 5% to 10% the industry average, with below 5% more desirable2. The result is what is at stake, not what will be collected.
How this is calculated
Denied claims per month = claims per month × denial rateDollars denied per month = denied claims × average claim valueUnworked denials per month = denied claims × (1 − share reworked)Dollars left unworked per month = unworked denials × average claim valuePer year = per month × 12
Benchmark and reference sources: Strategic improvements in your RCM to reduce your practice's claim denials (MGMA Stat), MGMA; Practice Finances and Revenue Cycle Management: Denial rate, American Academy of Family Physicians.
Benchmarks are industry figures from the sources listed; they are not Remitwright results.
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How it is worked out
The formula
- 01
Denied claims per month = claims per month × denial rate - 02
Dollars denied per month = denied claims × average claim value - 03
Unworked denials per month = denied claims × (1 − share reworked) - 04
Dollars left unworked per month = unworked denials × average claim value - 05
Per year = per month × 12
Assumptions and limits
- Denial rate is the share of claims denied on first submission, by count. If you only know the dollar share, enter it and read the result as dollars rather than claims.
- The two benchmarks measure different things: MGMA's 8% counts claims denied on first submission, while the AAFP's 5% to 10% range divides denied dollars by submitted dollars.
- Average claim value is the expected payment, not the charge. Using charges overstates the leak.
- Not every unworked denial is recoverable. Some are correct denials, some are patient responsibility, some have passed the appeal window. The figure is what is at stake, not what will be collected.
- Share reworked means denials that were corrected, appealed or resubmitted, not denials that were logged. If you do not track it, start with the share your team can show you evidence for.
Next step
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Three quick questions, no patient data. Paste the result in the note if you like. A billing specialist replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
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A written reply by email
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- A billing specialist reads your answers and replies by email.
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- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how to work claim denials. You can also download the sample weekly report (PDF).