See what your practice saves by replacing manual billing workflows with AI-powered automation. Adjust the sliders to match your volume.
Outsourced Billing & RCM Fee (4–7% of net collections): The industry-standard fee charged by third-party medical billing and revenue cycle management companies. Per MGMA (2025), outsourcing fees average approximately 5% of net collections — an amount that scales directly with revenue regardless of the work performed. This calculator defaults to 5%. MGMA notes that 36% of practices planned to outsource or automate part of their RCM in 2025 due to the growing complexity of in-house billing.
Billing Staff Rate ($20.00/hr): Based on PayScale's 2026 report, the average hourly pay for a Medical Billing Specialist in the U.S. is $20.02/hr. The U.S. Bureau of Labor Statistics (BLS) May 2024 Occupational Employment Survey reports the median annual wage for Medical Records Specialists at $50,250/year ($24.16/hr). This calculator uses the $20.00/hr figure as a conservative baseline. Fully loaded cost including employer payroll taxes, health benefits, and PTO is typically 25–35% higher.
Prior Authorization Administrative Burden: According to the AMA's 2024 Prior Authorization Physician Survey — the largest annual PA survey in the U.S. — physicians complete an average of 43 prior authorization requests per physician per week, consuming approximately 12 hours of physician and staff time weekly. More than 27% of physicians report that PA requests are often or always denied, and 95% say PA somewhat or significantly increases burnout. More than a third of practices (35%) employ staff exclusively to handle prior authorizations.
Eligibility Verification Cost: Industry benchmarks from CAQH (2023 Index Report) and MGMA indicate manual or legacy-tool eligibility verification costs between $0.75–$3.00 per transaction when accounting for staff time, tool fees, and rework from unverified coverage. CAQH reports that 35% of health plans had adopted fully electronic prior authorization as of 2023 — meaning the majority still rely on manual or hybrid processes. This calculator defaults to $1.50 per inquiry as a mid-range estimate.