How to work out your rate
Your clearinghouse or billing system reports claims denied on first submission. Divide them by the claims sent in the same month.
What do denied claims cost your practice?
See what refused claims cost each year, in money written off and staff time spent working them again.
What you get
- Write-offs and rework, worked out as you type
- A source for every starting figure
- A printable report with the 4 changes worth most
Step 1 of 3
Your practice
Example. Use your own.
MGMA, 2024
AAFP Family Practice Management, 2015
Example. Use your own.
AAFP Family Practice Management, 2015
Everything stays in your browser.
Denials, measured
What a denial costs
A denial costs either the claim, when nobody works it again, or the staff time to correct and resend it. The calculator adds both.
Where denials start
Many start at the front desk: coverage that wasn't checked, an authorization that wasn't requested, a member number typed wrong.
What practices do about it
They check coverage before every visit, request authorization when the visit is booked, and give every denial an owner the day it arrives.
Modulon checks every visit before the claim goes out.
Modulon checks coverage before each visit, fills in authorization requests from the chart and suggests a fix for each denial. Your team signs and approves each one.
See a day at a practiceCoverage checked the night before
Problems are fixed with the patient before they arrive.
Authorizations filled in from the chart
A provider reviews and signs each request before it's sent.
A fix suggested for every denial
Your billing team approves each correction and appeal.
Frequently asked questions
MGMA's 2023 data showed single-specialty practices had 8% of claims denied on first submission. In a March 2024 MGMA poll, 60% of medical group leaders said their denial rate had risen.
No. The calculator runs in your browser. If you ask for the report, we receive your contact details and your result, as our Privacy Policy describes.
MGMA data cited by the AAFP found that more than 50% of denied claims are never reworked. The calculator starts from 50%, and you can change it.
The 2024 CAQH Index puts a manual eligibility check at $8.57 and 16 minutes for a provider, against $2.00 and 4 minutes electronically.
Something else? Ask us directly.