OB/GYN revenue leakage calculator

How the revenue leakage calculator works

This calculator gives you a quick, rough estimate of how much revenue your practice may be losing to common billing gaps. It's a starting point for a conversation — not an audit. Real recovery depends on why claims are denied, how old your A/R is, your payer contracts and your documentation.

The calculator uses four inputs you can usually pull from your practice management system's monthly reports:

• Monthly gross charges — the total amount billed at your fee schedule rates
• Monthly contractual adjustments — the difference between your charges and what payers have agreed to pay
• Monthly payments received — insurance and patient payments posted in the month
• Claim denial rate — the share of claims denied on first submission

The formulas

Net collection rate (NCR) measures how much of the money you're contractually entitled to you actually collected:

NCR = Payments ÷ (Gross charges − Contractual adjustments) × 100

Estimated collectible revenue not collected is the gap between your expected collectible revenue and payments:

Gap = (Gross charges − Contractual adjustments) − Payments

Estimated annual cost of denials assumes a portion of denied claim value is never recovered — many practices never rework a meaningful share of their denials:

Denial cost = (Gross charges − Contractual adjustments) × Denial rate × Unrecovered share × 12

We use a conservative unrecovered share in the calculator. Your actual figure could be higher or lower.

Interpreting your results

Net collection rate

Net collection rate is the most useful single measure of billing performance because it removes contractual adjustments from the equation. A low NCR usually points to denials that weren't worked, underpayments that weren't caught, timely-filing write-offs or patient balances that weren't collected. Be careful comparing your NCR to numbers you see online: published benchmarks vary, and a single month can be distorted by payment timing. Look at a rolling three- to six-month average.

Denial rate

Your denial rate tells you how much rework your team is doing. Every denied claim costs staff time to investigate, correct and resubmit — and some never get reworked at all. In OB/GYN, a large share of denials come from eligibility, authorization, bundling and modifier issues, most of which are preventable. See denial management.

The collectible gap

The gap between expected collectible revenue and payments in any single month includes claims that simply haven't been paid yet. That's normal. The concern is when the gap doesn't close over time — that's revenue at risk.

What the calculator can't see

Some of the most important OB/GYN revenue gaps never show up in these four numbers because the charges were never created in the first place:

• Unbilled antepartum care when a patient transfers out or changes insurance mid-pregnancy
• Separately billable services absorbed into a global maternity package — ultrasounds, non-stress tests, complication visits
• Undercoded surgery — hysterectomies billed at the wrong weight tier, missing adnexal procedures
• Missed device codes for IUDs and implants
• E/M levels below what the documentation supports
• Underpayments below your contracted rates, which look like normal payments

Finding these requires looking at claims and documentation — which is what our free audit does. See global maternity billing, GYN surgery coding and fee schedule optimization for how we find them.

Where to find your numbers

Most practice management systems provide a monthly summary or "month-end" report with charges, adjustments and payments. Your denial rate may come from your clearinghouse or a denial report in your PM system. If you can't find a number, use your best estimate — the calculator is meant to be quick.

A worked example

Suppose an OB/GYN practice reports, for a typical month:

• Gross charges: $150,000
• Contractual adjustments: $60,000
• Payments received: $80,000
• First-pass denial rate: 12%

Expected collectible revenue is $150,000 − $60,000 = $90,000. The practice collected $80,000, so its net collection rate is about 88.9%. The monthly gap of $10,000 — about $120,000 a year if it persisted — includes claims still in process, but if the gap doesn't close over the following months, much of it is revenue at risk.

With a 12% denial rate and an assumption that 30% of denied dollars are never recovered, the estimated annual cost of unrecovered denials is $90,000 × 12% × 30% × 12 ≈ $38,900.

These are illustrative numbers. Yours will differ — which is why the calculator lets you change every input and the unrecovered-denial assumption.

Five quick ways to improve the numbers

1. Verify eligibility before every visit — and re-verify during pregnancy — to prevent the denials that coding can't fix.
2. Work every denial within two business days. Older denials are harder to overturn and closer to appeal deadlines.
3. Track open pregnancies and unbilled deliveries so obstetric revenue isn't forgotten.
4. Hold surgical claims for pathology so hysterectomy and myomectomy claims are billed at the right tier.
5. Compare payments to contracted rates to catch underpayments that look like normal payments.

Our denial management and revenue cycle management services build these habits into your billing.

How this calculator differs from an audit

Use the calculator to decide whether billing deserves a closer look. Use the audit to find out exactly what's happening.

Who should use this calculator

The calculator is designed for practice owners, administrators and billing managers at independent OB/GYN practices who want a quick sense of whether billing performance deserves attention. It works for any specialty, but the guidance on this page focuses on women's health, where global maternity billing and surgical coding create gaps that summary numbers can't show.

Next step: replace estimates with facts

An estimate is useful for deciding whether billing deserves a closer look. If the numbers concern you, send us a WhatsApp message. We'll review a sample of your actual claims, remits and A/R for free and tell you what we see — no form required.

This calculator provides estimates for informational purposes only. It is not a guarantee of any revenue recovery or financial result.