ROI Guide
A Practical Guide to Calculating ROI
for Healthcare Billing
Use this guide alongside our calculator to estimate financial impact using conservative, industry-aligned assumptions.
Key Benchmarks
Anchor your estimates using conservative targets
Clean Claim Target
≥ 95%
Days in AR Target
≈ 18 days
Staff Savings
20–40%
Typical Payback
3–9 months
1. What is ROI in Healthcare Billing?
- ROI (Return on Investment) measures financial gains relative to costs incurred.
- In revenue cycle management, ROI is driven by higher collections, faster payments, and reduced administrative costs.
- Common levers: denial prevention, clean claim improvement, automation, and integration.
2. Inputs You Should Know
- Monthly claim volume and average claim value
- Current denial rate and clean claim rate
- Average days in AR (Accounts Receivable)
- Monthly staff costs for billing operations
- Platform subscription costs
3. Core ROI Formula
- Recovered revenue from improved clean claims = ΔCleanRate × Claims × AvgClaimValue
- Staff savings = CurrentStaffCosts × AutomationSavingsRate
- Payback period (months) = Annual Platform Cost ÷ Monthly Savings
- ROI % = ((Annual Savings − Annual Cost) ÷ Annual Cost) × 100
4. Benchmarks & Assumptions
- Target clean claim rate: 95%+
- Target days in AR: ~18 days
- Typical administrative savings from automation: 20–40%
- Use conservative assumptions to avoid overstating benefits
5. Where ROI Comes From
- Denial prevention and cleaner first-pass submissions
- Faster claims processing and remittance posting
- Automation of repetitive back-office tasks
- Eligibility, authorization, and payer integration improvements
- Analytics-driven prioritization and exception handling
6. Implementation Tips
- Start with one or two high-impact workflows (e.g., denials, eligibility).
- Track baseline metrics for 30 days pre-implementation.
- Roll out automation in phases and measure each phase impact.
- Validate payer-specific improvements via sample reports.
7. Communicating Results
- Show monthly recovered revenue and staff time saved.
- Present payback period and annualized ROI clearly.
- Tie results to patient experience: fewer billing errors, faster refunds, clearer statements.
Conservative estimates • Real customer benchmarks • Fast payback