Sandbox · The fall, priced

Set your own assumptions.

We fixed the arithmetic, not the answer. Move any lever and the curve recomputes to the dollar.

Inputs · native units · editable

Coverage

ED reads / yr

count

ED/trauma/overnight reads per year — replace with actual.

Avg wRVU / read

wRVU

CMS public RVU file via CPT→RVU. ED skews CT.

Conversion factor

$/wRVU

CMS CY2026 MPFS — $33.40 non-QP / $33.57 QP. Note: −2.5% work-RVU efficiency cut on non-time-based codes in 2026.

Payer mix · sum 100%

Medicare

% of ED

Site-specific — replace with the group's actual ED mix.

Medicaid

% of ED

Site-specific — replace with the group's actual ED mix.

Commercial

% of ED

Site-specific — replace with the group's actual ED mix.

Self-pay

% of ED

Pro-fee self-pay collection is near zero.

Collection vs Medicare (multiples of CF)

Medicaid (f_md)

× Medicare

Medicaid ~71% of Medicare (2024); ~68% for hospital/ED visits — Health Affairs / KFF Medicaid-to-Medicare fee index. TN omitted (TennCare is managed care, no published FFS physician fee); derive your actual from 835 remittances by MCO. Replace with your actual.

Commercial (f_comm)

× Medicare

Industry range ~150–300% of Medicare — replace with the group's contracts.

Self-pay

× Medicare

Pro-fee self-pay collection is near zero — replace with actual.

Fall pattern

Fall share of ED

Illustrative — replace with measured share of ED visits coded as falls.

Negative read rate

Illustrative — replace with measured normal/clean rate on fall head CTs.

Waste reduction

Achievable reduction in unnecessary 'fall' reads — your assumption.

Hospital-side (CFO enters)

Technical cost / CT · CFO-supplied · illustrative

CFO-supplied · illustrative. Hospital technical-component cost per CT — replace with actual.

Denial write-off (permanent) · scenario

PERMANENT write-off rate on technical revenue (not gross denial rate). Net-collection benchmarks ~4–5%. Feeds the separate denial-recovery scenario only — never compounded into the base hospital pocket.

★ Lost-study reconciliation

Lost-study rate · % of coverage

Share of completed reads (worklist) never billed (billing). Typical slip 0.5–1.5%; your reconciliation reveals the real figure. Illustrative.

Mode

Coverage gap vs Medicare · today

No-pay (self-pay)

20,250 wRVU·$676K

Medicare-equivalent value of work that collected nothing.

Underpayment shortfall (Medicaid below Medicare)

12,960 wRVU·$433K

The gap vs Medicare on Medicaid volume.

Subtotal · Coverage gap vs Medicare

$1.11M

at 0.90 wRVU/read · $33.40/wRVU · self-pay 15% · Medicaid 30% × f_md 0.68 · illustrative

The Group · pocket

$69K/ yr

Capacity recovered from removing unnecessary 'fall' reads, refilled at the blended rate ($38.96/wRVU). Illustrative.

The Hospital · pocket

$436K/ yr

Cost the hospital didn't incur on avoided scans (1,980 × $220/CT, CFO-supplied · illustrative). Denial recovery shown separately below.

Denial recovery (scenario) · permanent write-off

avoided_scans × technical_cost_per_CT × denial_writeoff_pct. Add-on, not part of the headline hospital pocket.

$22K/ yr

The patient

1,980unnecessary scans / yr avoided

Less radiation. Freed capacity for the demand that never stops growing.

$69K

TO THE GROUP / YR

$436K

TO THE HOSPITAL / YR

1,980

FEWER UNNECESSARY SCANS / YR

All figures illustrative. Sample data.

Tick states: ● filled from your data · ◌ dashed from an assumption you set, not yet your data · ○ empty not used. Feeds: billing / production / workflow. Billing = 837/835 claim & remittance EDI (Electronic Data Interchange). Production = reads completed and work RVU (wRVU = work Relative Value Unit) output. Workflow = PACS (Picture Archiving and Communication System) timestamps, shift / site / orderer metadata. Acronyms: ED = emergency department, CARC = Claim Adjustment Reason Code.

Leak → residual · illustrative

Plug a leak. Watch it land in the bonus pool.

The partner bonus is a residual — collections minus a fixed cost base. Recovered dollars are near-pure margin, so they flow almost entirely into the residual. Each lever is illustrative; replace with your own.

Residual delta · into the bonus pool

$286K/ yr

≈ 7,330 wRVU

residual_delta ≈ recovered_$ · fixed cost base → ~100% to residual · $38.96/wRVU blended

Bill the lost studies

lost_study_count × avg_wRVU × blended_$/wRVU

recovered · illustrative

$53K

From the ★ panel. 1.0% slip × 1500 reads. Replaceable.

Recover commercial underpayments

commercial_underpayment_$ × recovery_rate

underpayment $

recovery rate

recovered · illustrative

$125K

Payers paying below contracted rate. NOT the Medicaid-vs-Medicare gap (that's structural, not recoverable here).

Fix the top denial pattern

preventable_denial_$ × fix_rate

preventable $

fix rate

recovered · illustrative

$108K

One pattern, one workflow tweak. Illustrative; replace with your top CARC.

All figures illustrative. Sample data.

Productivity → bonus · illustrative teaching model

Slide your productivity. Watch your bonus.

A hypothetical model — separate from the reconciled outputs above. Every assumption is yours; the curve is whatever your numbers say.

bonus / partneryour sliderunsustainable pace zone

Avg wRVU / radiologist / yr — THE slider9,000 wRVU

4,000sustainable ≈ 12,00016,000

Avg yield

$53.85/wRVU

Bonus / partner

$35K

bonus / partner

Next 1,000 wRVUs add

$39K

at coverage yield $38.96/wRVU

After-hours coverage gap

$12K

Here is the after-hours coverage the rate doesn't cover — the stipend ask, sized.

night_w 500 wRVU × (y_core − y_night) = $24.54/wRVU · per partner

Structural vs avoidable split

coverage_shortfall = $17K

avoidable_gap · hospital's lever

$7K

This is the hospital's shared-waste lever — not money the group recovers. Reducing avoidable work reduces the group's own volume; we say so plainly.

structural_gap · what you carry

$10K

Coverage you'd still be on the hook for. The stipend conversation.

Overlapping lenses on the same cov_w — never one combined total. Per partner.

Illustrative model. Set your own assumptions — your curve is yours.

Your numbers · illustrative · editable

w_core

wRVU

Productivity up to which work is core/well-paid · PLACEHOLDER · clinical lead

w_sustainable

wRVU

Sustainable annual ceiling — greyed band beyond · PLACEHOLDER · clinical lead

y_core

$/wRVU

Derived from CORE mix × money module CF. Override to test. Derived = $55.71/wRVU.

y_cov

$/wRVU

Derived from COVERAGE mix × money module CF. Override to test the honesty rule (set near y_core — curve keeps climbing). Derived = $38.96/wRVU.

F · overhead / partner / yr

PLACEHOLDER · CEO / finance

B · base comp / partner / yr

PLACEHOLDER · CEO / finance

N · partners

count

PLACEHOLDER · partner count (genericize for white-label)

Range · w_min – w_max

wRVU

Default slider range. Default w = 9,000. PLACEHOLDER · clinical lead.

Workflow layer · from your worklist — estimate for now

night_share

0–1

Share of coverage work done after-hours. From your worklist — estimate for now.

y_night

$/wRVU

After-hours yield. From your worklist — estimate for now. Default seeded below y_cov ($31.17/wRVU).

avoidable_share

0–1

Share of coverage work deemed avoidable (low-yield). From your worklist — estimate for now. Needs the group's clinical low-yield definition.

Shared constants (CF, payer multiples) read from the money module — single source of truth.