Denial Rate Calculator

Claims denial rate and revenue impact analysis.

Total claims per month

Current denial rate (%)

Avg claim value ($)

Appeal success rate (%)

Cost per appeal ($)

Target denial rate (%)

Billing staff hourly rate ($)

Tab to move between fields

Denied claims per month

120

Annual revenue at risk

$266,400.00

≈ 6 Teslas

Clean claim rate92%

Monthly revenue at risk$22,200.00

Monthly recovered via appeals$6,475.00

Annual appeal costs$43,056.00

Net annual revenue lost$188,700.00

Savings from hitting target$133,200.00

Est. days in AR impact16

Annual Recovered77,700

How to Use This Calculator

Enter Total claims per month and your Current denial rate (%) — the national average is 5–10%.
Input Avg claim value and Appeal success rate (%) to model the revenue recoverable through the appeals process.
Set Cost per appeal and Billing staff hourly rate to capture the true cost of working denials.
Enter your Target denial rate (%) to project the Savings from hitting target after implementing improvement initiatives.
Review Monthly revenue at risk and Annual revenue at risk to quantify the business impact of current denial levels.
Use Days in AR impact and Clean claim rate to benchmark performance and set billing team improvement goals.

How the result changes with Total claims per month

Total claims per month: Total number of claims submitted per month across all payers.
Current denial rate (%): Percentage of claims initially denied. Industry average is 5-10%.
Avg claim value ($): Average dollar amount per submitted claim.
Appeal success rate (%): Percentage of appealed claims that are overturned. National avg ≈ 40-50%.
Cost per appeal ($): Direct cost per appeal (postage, forms, IT). Does not include labor.
Target denial rate (%): Desired denial rate after improvement initiatives.
Billing staff hourly rate ($): Fully loaded hourly rate for billing/appeals staff.

Denied claims per month: Number of claims denied each month.
Clean claim rate: Percentage of claims accepted on first submission. Target ≥ 95%.
Monthly revenue at risk: Total dollar value of denied claims per month.
Annual revenue at risk: Annualized denied claim revenue.
Monthly recovered via appeals: Revenue recovered from successful appeals each month.
Annual appeal costs: Total labor + direct costs to process appeals annually.
Net annual revenue lost: Revenue lost after appeal recoveries.
Savings from hitting target: Annual revenue saved by reducing to target denial rate.
Est. days in AR impact: Estimated additional days denials add to accounts receivable cycle.

Identify Input Parameters
4 parameters
Total claims per month = 1500, Current denial rate (%) = 8, Avg claim value ($) = 185, Appeal success rate (%) = 45 = 7 input(s) provided
Calculate Denied claims per month
Denied claims per month
120 = 120
Calculate Annual revenue at risk
Annual revenue at risk = monthlyRevenueAtRisk * 12
266400 = $266,400
Calculate Clean claim rate
Clean claim rate = (cleanClaimsPerMonth / totalClaimsPerMonth) * 100
92 = 92%
Calculate Monthly revenue at risk
Monthly revenue at risk = deniedClaimsPerMonth * avgClaimValue
22200 = $22,200