Bottom line
1 minThe scenario book denied $607.7M in six months. $151.4M is still open, and at historical behavior about $26.4M of it will be written off unless staff time moves to where the loss is.
Three things should never reach leadership from someone else first: the largest commercial payer's denials doubled in the final month; 60% of authorization denials went out with no auth number on the claim; and medical necessity loses almost one in three dollars, twice the book rate.
The loss is concentrated. Working the highest-risk 35% of open dollars addresses about three quarters of the forecast loss.
Six numbers to carry
1 minPayer A monthly denials
$M by month, months 1 to 6. Dashed line: months 1 to 5 average, $13.1M
Where the forecast loss sits
Expected write-off by risk tier, share of $26.4M
Payer watchlist
1 minDrift compares the last two months of inflow to the first two. Above 1.25x means the problem is accelerating. Payers are archetypes, not named carriers.
| Payer archetype | Denied | Open | Loss rate | Drift | What is driving it | Status |
|---|---|---|---|---|---|---|
| Payer ARegional Blue, commercial | $92.0M | $32.5M | 11.0% | 1.47x | Month 6 spike; contract, bundling | ALERT |
| Payer BRegional Medicare Advantage | $12.1M | $3.2M | 12.8% | 2.08x | Missing claim info 4.3x | ALERT |
| Payer CMedicaid managed care | $25.3M | $7.1M | 20.9% | 1.26x | Coding 4.5x, missing info 4.0x | ALERT |
| Payer DMedicaid managed care | $12.0M | $3.0M | 36.9% | 1.23x | Coding 5.4x, auth 2.1x | ALERT |
| Payer EMedicaid managed care | $21.8M | $7.6M | 28.4% | 1.15x | Add'l docs 3.4x; coding loses 80% | ALERT |
| Traditional MedicareFee for service | $58.5M | $5.6M | 20.3% | 1.16x | Miscellaneous 5.7x; med nec | ALERT |
| Payer FNational commercial | $18.8M | $5.7M | 9.1% | 1.46x | Steady climb all six months | WATCH |
| Payer GNational Medicare Advantage | $27.4M | $7.6M | 19.9% | 0.68x | Add'l docs 4.5x ($14.2M) | WATCH |
| Payer HBehavioral health MCO | $12.4M | $2.4M | 8.7% | 0.42x | Falling; confirm it is real | IMPROVING |
Loss rate is the dollar-weighted write-off share of closed records for that payer. Book average is 15.8%.
If you are asked
1 minAbout $26.4M of the $151.4M open book at current behavior, with $16.0M of it in the high-risk tier. Triage by propensity instead of by age brings that down.
Both, and we can separate them. 43% of denied dollars are flagged preventable on our side, yet 58% of audited surgical auth denials were payer error.
A hard stop at claim edit for a missing authorization number. It touches 60% of auth denial records in a category that loses 21.7% of dollars.
In this tool, they are a simulation. Swap in your own extract before quoting anything. In a live book, also check how much sits in an unspecified category.
Round the floor
5.5 minTake each stop to the owner. Ask the question, record what you hear, and set a status. Your entries stay in this browser only and build the summary below.
Rounding summary
About this tool. ReveIQ Tool 23 pairs a short command center brief with a structured leader round. Each stop is a blind spot a VP of Revenue Cycle should hear about from their own team first.
Method. This is a simulation. The denial book, payer archetypes and every dollar figure are illustrative and do not represent the actual results of any hospital, health system or insurance carrier. Forecast loss applies a historical write-off rate for each payer and category combination to open balances, blended toward the book rate where data is thin. Risk tiers: High 25% or more, Elevated 15 to 25%, Moderate 8 to 15%, Low under 8%. Drift divides the last two months of inflow by the first two.