Revenue Risk calculator
Prior Authorization Revenue Risk Calculator
Authorization denials are frustrating because the care was real and the claim is still refused: no auth on file, auth for different codes, or dates outside the approved window. This calculator estimates the revenue.
What this calculator shows
Authorization denials are frustrating because the care was real and the claim is still refused: no auth on file, auth for different codes, or dates outside the approved window. This calculator estimates the revenue exposed to that failure mode, from the claims that need authorization, what they reimburse, and the share that hit authorization problems in your recent experience.
We call it revenue at risk, not lost. Some is recovered by retro-authorization or appeal; some is not. The point of the number is to size the process, not to write the money off.
Revenue Risk calculator
Prior Authorization Revenue Risk Calculator
The revenue riding on authorizations being right before the visit.
How the calculation works
Revenue in auth-required claims = claims x average reimbursement. Revenue at risk = that value x authorization denial/delay percentage. Annualized is the monthly figure x 12.
How to read your result
The fix is a front-end habit: verify the auth requirement, the approved codes and the date window before the visit, and track approvals where schedulers can see them. Our prior authorization service runs that check as a routine, and for Texas practices the Texas gold card prior authorization guide explains when experienced providers are exempt from some requirements.
Looking for another measure? See all medical billing calculators or the formulas collected in our medical billing KPIs guide.
Before you rely on the number
Results are estimates for educational and operational planning, built from the figures you enter. They are not guarantees of reimbursement, savings or recovery, and they do not replace a review of your own claims, contracts and remittances. Do not enter patient-identifiable or protected health information: this calculator runs in your browser and nothing you type is stored or sent anywhere.
FAQ
Calculator questions
Still have a question? Talk to our team about your billing workflow.
What counts as an authorization problem?
No authorization when one was required, codes billed outside the approved set, dates outside the approved window, or an auth obtained for the wrong provider or location.
Can authorization denials be appealed?
Sometimes, with documentation that care was authorized or medically necessary; retro-authorization rules vary by payer. The deadline matters, so work them first.
Where do I get the denial percentage?
Your denial report filtered to authorization denial reasons, divided by authorization-required claims for the same month.
Want this run on your real claims?
A free billing assessment reviews your actual denials, A/R and contracts, then gives you these numbers from your own data, in writing, before you decide anything.