The 7-Day Clock: How CMS-0057-F Is Already Costing DME Suppliers Revenue . To protect your revenue → Register Now

Margin-at-Risk Calculator

See how much buy-and-bill margin your infusion center is losing to documentation gaps — and what dropping denials to under 5% recovers.

Your Operation

Total active treatment chairs across your sites

chairs

Industry typical: 8–12 for biologics; higher for oncology/IVIG

/chair/wk

Typical: 10–20% for biologic and specialty claims before optimization

%

CMS estimates 60–70% trace to eligibility, prior auth, or coding errors

%

Net margin after overhead and acquisition (typical: 5–10%)

%

Approximate mix — remainder is priced as blended "other infusibles". Demo ASP rates shown.

% of mix
% of mix
% of mix

Remaining mix (10%) is priced as blended other infusibles ($3,500).

Adjust the assumptions — every factor is editable

The expected case uses the values below. Change anything — the math updates live.

Operating weeks used to annualize volume. Conservative case uses the same.

weeks

The conservative case recovers this share of the expected figure.

%

Flat rate, unlimited users

$/yr
Preventable denial loss recovered / year
$1.28M$1.82M
Conservative → expected range, capped at the real gap between your denial rate and a 5% floor.

Preventable denial loss recovered (to a 5% floor)

Recovery is capped at BOTH the documentation-preventable share (65% of losses) AND the actual gap between your 14% denial rate and a 5% floor — whichever is smaller. No flat percentages.

$1.82M
Conservative $1.28M
Show the math
5,400 infusions/yr × $3.8K blended = $20.25M annual reimbursement
Current denial loss: $20.25M × 14% = $2.83M
Documentation-preventable: × 65% = $1.84M
Gap to 5% floor: $20.25M × 9pts = $1.82M
Expected = min(preventable, gap) = $1.82M
Conservative: × 70% success = $1.28M
Net Year 1 · Expected
$1.76M
Net Year 1 · Conservative
$1.22M
Annual Infusions5,400
Annual Reimbursement$20.25M
Gross Margin (8%)$1.62M
Recovery / Margin113%
Recovered / Chair$152K/yr

5-Year Projection

%/yr
5-yr Net (Expected)$10.39M
5-yr Net (Cons.)$7.18M
Payback Period~2 weeks
5-yr Value/Cost Ratio35.6x
Loading Chart Data...

Interested in a custom ROI analysis for your specific operation?Contact our strategy team