ROI CALCULATOR
What it costs when a provider sees patients before payer participation is active.
Four short steps. Every figure below updates as you type — there is no calculate button. Change any assumption you disagree with; that is what the tool is for.
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PERMANENT LOSS
per provider hired, at today's gap
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VALUE RECOVERED
per year, with RIEL
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PAYBACK
months to pay back year one
Assumptions
Your center
Size and cadence. These drive how many credentialing and enrollment events happen in a year.
The enrollment gap
The gap splits into three segments: the days you take to submit, the days lost to returned or deficient applications, and the payer's own processing time. RIEL acts on the first two. It does not make the payer move faster — the payer's days are entered per payer in step 3.
Billable under supervision is at 100%: every visit in the gap is billed under a participating supervising provider, so the permanent loss is zero by construction. That is a valid position — the calculator allows it and says so rather than hiding it.
Supervision is the most disputed assumption in this model, which is why it is a field and not a constant. Raise it and the loss falls immediately.
Your payer mix
One row per payer. Retroactive days is the window in which you can still bill for services delivered before the effective date; payer days is that payer's own processing time, which RIEL does not shorten.
| Payer | % of visits | Rate / visit | % collected | Retro days | Payer days | Remove |
|---|
The uninsured / sliding-fee row carries a rate of 0. It contributes nothing to the result and exists so the mix adds to 100%; delete it and enter your own split if you prefer.
Economics
What an administrative hour costs, how much of a saved hour turns into money, and what RIEL costs.
The realization factor is deliberately conservative at 50%. Saved hours only become dollars if you avoid a hire, cut overtime or contractor spend, or move that person onto revenue-generating work. Otherwise the benefit is freed capacity — real, but not a line in the income statement.
Advanced — hours per event and reduction factors The 18 assumptions behind the administrative hours. Change them only if you have measured your own.
Manual hours per event
Reduction with RIEL
REVENUE AT RISK — PER PROVIDER HIRED
Three levels, never collapsed into one.
Gross exposure is what the visits were theoretically worth. Only the third number is money that never arrives.
Every gap segment is zero, so there is no revenue at risk to measure. Every figure in this section is zero by construction, not by error.
All theoretical revenue from visits delivered during the gap, before any adjustment.
What can still be billed inside each payer's retroactive window, net of collection rate and of what was billed under supervision.
Revenue that will never arrive. This is the headline number, not level 1.
Over a mix-weighted gap of — calendar days the center paid — in provider payroll while — of revenue went permanently unbilled. These two are shown side by side and are never added together: the salary is incurred once the hire is made, gap or no gap.
By payer
| Payer | Gap days | Non-recoverable days | With RIEL | Permanent loss | With RIEL | Recovered |
|---|
Annual administrative load
| Hours under manual process | — |
|---|---|
| Hours with RIEL | — |
| Hours saved | — |
| FTE equivalent freed | — |
| Loaded cost per hour | — |
| Gross value of the hours | — |
| Recognizable saving | — |
The recovered revenue above is an order of magnitude larger than this saving. Recovered revenue is the argument; hours saved are the backing, and leading with the hours would trade the strong case for the weak one.
Return on investment
| Annual revenue recovered | — |
|---|---|
| Recognizable administrative saving | — |
| Adjusted annual benefit | — |
| Year 1 investment | — |
| Year 1 ROI | — |
| Recurring ROI | — |
| Payback | — |
| Net benefit over 3 years | — |
BREAK-EVEN THRESHOLD
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HOW THIS IS CALCULATED
What this model assumes.
Three things this model will not pretend
RIEL does not make the payer move faster. The gap has three parts: the days your own operation takes to submit, the days lost to returned or deficient applications, and the payer's processing time. Only the first two are yours, and only those are the ones this calculator reduces. The payer's days are entered per payer and pass through the model untouched.
Provider payroll during the gap is never added to the revenue loss. It is reported beside it, because the salary is incurred the moment the hire is made, gap or no gap. What the gap actually causes is that no revenue backs it. Adding the two together would inflate the result, and it is the kind of double count a CFO spots in thirty seconds.
Saved hours are not saved dollars. They only turn into money if the center avoids a hire it was going to make, cuts overtime or contractor spend, or moves that person onto work that generates revenue. If none of that happens, the benefit is freed capacity — real and worth having, but not a line in the income statement. That is exactly what the realization factor is for, and why it is set conservatively rather than at 100%.
Modelling choices worth arguing with
The uninsured / sliding-fee row is included at a rate of zero rather than left out of the mix, so the shares add to 100% and the denominator is your whole panel.
Days are calendar days throughout, including the payer's processing days, and visits are prorated by the clinical schedule so a calendar-day gap and a clinical-day week stay consistent with each other.
The break-even threshold is solved numerically over the days of gap reduction and uses recovered revenue only. The administrative saving is deliberately left out of that question, so the answer does not lean on the softer of the two benefits.
Regulatory anchors
42 C.F.R. § 424.521 — physicians, non-physician practitioners and their organizations may bill Medicare retrospectively for services furnished up to 30 days before the enrollment effective date where circumstances precluded enrolling in advance, and up to 90 days where a Presidentially-declared disaster under the Stafford Act intervened. That fixes the Medicare default at 30 retroactive days, with 90 available as a scenario.
42 C.F.R. § 424.520(d) — the effective date is the later of the filing date of the application that was subsequently approved and the date the provider first began furnishing services. This is precisely why the internal days to submission carry a direct, measurable financial consequence.
Puerto Rico Medicaid — provider registration runs through the PEP portal. CAQH is not used in Puerto Rico. Retroactivity depends on the contract with each MCO; the prudent default here is 0 days, to be raised only if your executed contract says otherwise.
Commercial plans — the effective date is usually contract execution or credentialing-committee approval. Prudent default: 0 retroactive days.
This tool produces estimates based on the assumptions you enter. It is not legal, accounting or billing advice. Retroactive windows, per-encounter rates and supervision billing rules vary by payer and by contract; verify them against your contract in force before making financial decisions. The reference to 42 C.F.R. §§ 424.520 and 424.521 applies to Medicare enrollment and does not describe Puerto Rico Medicaid or commercial plan rules.