Your Practice Data
Estimate is fine. Use your most common procedure value.
Staff Time Cost
Include submissions, follow-ups, appeals, and portal logins.
Fully loaded rate including benefits. $25/hr is typical.
Your Prior Auth Approval Rate
Approval Rate
Denials per quarter
Prior auths not approved in the last 3 months
Denials being appealed
Based on your appeal rate
Revenue at risk (quarterly)
Denied claims × avg reimbursement
Estimated annual exposure
If denial rate holds, before appeals
How You Compare: Your Specialty
Revenue Written Off: Unappealed Denials
The total dollar value of denials your practice did not appeal. This revenue was earned clinically and lost administratively. Most practices have never seen this number.
Estimated Recoverable Revenue (If Properly Challenged)
An estimate, using the 81.7% of appealed Medicare Advantage prior auth denials that were fully or partially overturned (KFF analysis of federal data). Your payers and results will vary.
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Benchmarks based on published specialty-level prior authorization data. Individual results vary by payer mix, specialty, and documentation practices.