2026 Healthcare Benchmark Engine

Calculate Your Recoverable Revenue

Discover the exact financial impact of automated 835 remittance parsing and AI-assisted clinical appeal generation.

2026 Arithmetic Engine

Estimate Your Recoverable Revenue

Grounded strictly in HFMA, Premier Inc., and KFF published overturn statistics.

Number of Rendering Providers18 Providers
12550100+
Monthly Billed Collections / Charges$1,500k / mo
$200k$2.5M$5.0M$10M
Initial Claim Denial Rate(Industry Avg: 11.8% Experian)11.8%
4% (Top Quartile)11.8% (Avg)25% (High Exposure)
% of Denials Your Team Has Time to Appeal(Industry: only ~35% HFMA)35%
10% (Severe Backlog)35% (US Average)90% (Near Full Rework)
Average Claim Value ($)$420
$100 (Primary/Therapy)$420 (Specialty)$2,500 (Surgical/Device)
Estimated Annual Recoverable Range
$828,360 – $1,076,868

Cash returned on claims your team currently writes off as unprofitable to work.

Annual Denied Dollars
$2,124,000
~5,057 total claims
The Unworked Write-Off
$1,380,600
65% abandoned without appeal
Manual Labor Spent Reworking
$289,412
At $57.23/claim (Premier Inc.)
Estimated Net ROI Multiple
12.2x Payback
Net of RecoupOps platform cost
Standard Benchmark Assumptions: Overturn rate benchmarked at 70% (Premier Inc. published findings). Manual labor rework cost benchmarked at $57.23/claim (Premier Inc. 2023). Denial rate benchmarked from Experian Health State of Claims 2025.
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Calculator Methodology & Citation Grounding

1. Baseline Denial Rates: Initial denial rate default (11.8%) is sourced from Experian Health's State of Claims 2025 study (n=250 revenue cycle leaders).

2. Unappealed Denial Share: The default assumption that 65% of denials are never appealed or reworked is the canonical national benchmark published by the Healthcare Financial Management Association (HFMA).

3. Overturn Benchmark: Overturn success rate ranges (60% to 78%) are derived from Premier Inc.'s comprehensive healthcare administrative research and KFF's August 2026 analysis of insurer CMS-0057-F disclosures (e.g. 67% in Medicare Advantage).

4. Manual Labor Expense: Manual rework expense ($57.23/claim) is benchmarked from Premier Inc.'s published 2023 administrative expense findings (up 30.5% from $43.84 in 2022).

Disclaimer: This model generates an estimate based on industry averages. Actual practice recovery varies by payer mix, specialty, clinical documentation quality, and timely filing compliance. RecoupOps makes no express warranty or guarantee of specific dollar recovery.
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