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RxGPT

ROI Methodology & Calculation Guide

Detailed formulas, assumptions, and worked examples behind our ROI projections.

1. Overview

RxGPT calculates projected ROI using a bottom-up model that estimates cost savings and revenue recovery across four operational areas: revenue cycle management (RCM), administrative labor, patient access, and denial prevention. Each projection is based on published industry benchmarks, customer-reported baselines, and conservative multipliers validated across our implementation cohort.

2. Core Formula

ROI (%) = [(Total Annual Savings − Annual Platform Cost) / Annual Platform Cost] × 100

ROI (%) = [(Total Annual Savings − Annual Platform Cost) / Annual Platform Cost] × 100

Where **Total Annual Savings** is the sum of savings across all operational areas, and **Annual Platform Cost** is the contracted subscription fee including implementation amortized over 12 months.

3. Savings Components

3.1 RCM Recovery

Revenue recovered from reduced claim denials, faster prior authorizations, and improved coding accuracy.

RCM Savings = (Baseline Denial Rate − Projected Denial Rate) × Total Claims Volume × Average Claim Value

Key assumptions

  • Baseline denial rate: industry average of 10-15% (MGMA, HFMA)
  • Projected denial rate reduction: 30-50% within first 12 months
  • Average claim value derived from client's payer mix

3.2 Administrative Labor Savings

FTE hours freed through AI-driven scheduling, document processing, and patient communication automation.

Labor Savings = Hours Automated per Week × Blended Hourly Rate × 52 weeks

Key assumptions

  • Blended hourly rate includes salary, benefits, and overhead (typically $28-45/hr for admin staff)
  • Automation rates calibrated per module: scheduling (60-70%), document intake (50-65%), follow-ups (70-80%)

3.3 Patient Access & Scheduling

Revenue uplift from reduced no-shows, increased appointment fill rates, and faster patient intake.

Access Savings = (Baseline No-Show Rate − Projected No-Show Rate) × Monthly Appointments × Avg Revenue per Visit

Key assumptions

  • Baseline no-show rate: 18-25% (national average per AMA data)
  • AI voice agents reduce no-shows by 35-50%
  • Average revenue per visit: client-specific, typically $150-$400 depending on specialty

3.4 Denial Prevention

Savings from preventing denials before claim submission through real-time eligibility checks and AI-assisted coding.

Denial Prevention Savings = Prevented Denials × Avg Cost-to-Appeal × Appeal Rate

Key assumptions

  • Average cost to appeal a denied claim: $25-118 per claim (AAPC benchmark)
  • Appeal success rate without AI: ~45%; with AI pre-submission review: denial avoidance of 60-70%

4. Payback Period Calculation

Payback Period (months) = Total Implementation + Platform Cost (first year) / Monthly Net Savings

Payback Period (months) = Total Implementation + Platform Cost (first year) / Monthly Net Savings

Implementation costs are amortized over the first year. Monthly net savings are calculated using a ramp-up curve: 25% of full savings in months 1-3, 60% in months 4-6, and 100% from month 7 onward. This reflects the typical adoption curve observed across our customer base.

5. Sensitivity & Assumptions

All projections use conservative multipliers (0.7x of maximum observed improvement). ROI calculators include three scenarios:

Clients receive a custom model populated with their operational data during the discovery phase. All assumptions are transparent and adjustable in the shared ROI workbook.

  • Conservative (P25): 70% of base-case savings, slowest ramp-up
  • Base Case (P50): expected savings with standard implementation timeline
  • Optimistic (P75): full potential savings with accelerated adoption

6. Data Sources & Benchmarks

  • HFMA (Healthcare Financial Management Association) — denial rate and cost-to-collect benchmarks
  • MGMA (Medical Group Management Association) — staffing ratios and operational cost data
  • AAPC (American Academy of Professional Coders) — coding accuracy and appeal cost data
  • AMA (American Medical Association) — no-show rates and patient access statistics
  • CMS (Centers for Medicare & Medicaid Services) — reimbursement rate references
  • RxGPT internal cohort data — anonymized, aggregated results from active implementations

7. Guarantee

RxGPT offers a 60-day money-back implementation guarantee. If the platform does not meet agreed-upon implementation milestones within the first 60 days, clients receive a full refund of platform fees paid during that period. ROI projections are reviewed quarterly with each client to ensure alignment between projected and actual outcomes.