Payer Operations · Right Skale

The $900B
Drain No One
Is Fixing

A quarter of U.S. healthcare spend never reaches a patient. It disappears into claims friction, prior auth overhead, denials rework, and FWA. Here is exactly where it goes — and what it costs to stop it.

Annual Administrative Waste
$900
Billion
~25% of total U.S. healthcare spend — lost every year to administrative inefficiency
$248B
Excess billing & insurance costs above what is necessary — Center for American Progress
$265B
Eliminable administrative waste — McKinsey / Health Affairs
$60B+
Lost annually to fraud, waste & abuse — PMC / NIH
25%
Of all healthcare spend is wasteful — nearly $1 in $4
JAMA 2019 · PGPF 2025
$1,055
Per-capita admin cost in the U.S. vs. $306 in Germany
OECD / CAP estimates
55.7%
Rise in Medicare Advantage claim denials — 2022 to 2023
AHA 2024
75%
Of payers still have no established AI strategy — 2024
Bain & KLAS Research 2024
The Scale

This Is Not a
Rounding Error. It Is the System.

The U.S. spends more on healthcare administration per capita than any other nation — by a factor of three. The waste lands hardest on Payors, MCOs, TPAs, and RCMs who sit at the center of every transaction. Five drains account for the majority of it.

Every dollar lost to administrative waste is a dollar that left your members' care — and landed in a process that delivered no clinical value to anyone.

Five Drains · Quantified

Where the Money
Disappears

$262B
Drain 01 · Claims
Claim Denials & Rework

9B+ claims/yr at $12–$40 each. MA denials up 55.7% in one year. 65% of denied claims are never resubmitted — revenue simply gone.

AHA 2024 · PMC/NIH · Industry benchmarks
$40–$50
Drain 02 · Per Auth
Prior Authorization Overhead

53M PA determinations in MA in 2024. Each costs $40–$50 per payer submission. Appeals rose from 7.5% to 11.5% in five years.

AHA 2025 · CAQH Index 2024 · CMS 2024
$43B
Drain 03 · Collections
Chasing Payments Already Owed

Hospitals spent $43B in 2025 collecting payments insurers already owed. $18B was spent overturning inappropriate denials alone.

AHA Costs of Caring 2025
$60B+
Drain 04 · Integrity
Fraud, Waste & Abuse

FWA costs $60B+ annually. Most is detected post-payment — or not at all. Real-time detection alongside billing would eliminate the lag entirely.

PMC / NIH · CMS estimates
$9.8B
Drain 05 · Revenue Cycle · Avoidable Manual Processing
Manual RCM — The Largest Single Opportunity

HFMA and TruBridge estimate $9.8B in savings from AI-powered RCM automation alone. Automating just 9 common transactions saves $20B+ annually (CAQH 2024). Yet only 25% of payers have an AI strategy. Claims that take 4–6 weeks to process manually resolve in hours with modern automation. The average hospital dedicates 64 billing staff — 6.5% of total headcount — to work that automation handles continuously, without error.

HFMA 2025 · TruBridge 2023 · CAQH Index 2024 · Bain & KLAS 2024 · AHA annual survey 2024
The Anatomy of a Broken Claim

Cost Accumulates
at Every Single Step

1
Service Rendered
$0 cost yet
Care delivered. Clock starts.
2
Eligibility Check
$7–$10
Point-in-time query. Status may have already changed.
3
Prior Auth
$40–$50
11.5% of all PAs require appeal. Each appeal costs more.
4
Claim Filed
$12–$40
4–6 weeks to process. Complex claims: $35–$40 each.
5
Denied
+$118 rework
MA denials +55.7% in one year. 65% never resubmitted.
6
Write-Off
Full loss
$18B spent overturning denials. Or: $0 recovered.
Global Context · Per-Capita Admin Spend

The U.S. Is Alone
at This Level of Waste

PER-CAPITA ADMIN SPEND (USD) $1,055 United States $306 Germany $243 Canada $183 France $120 Japan $97 UK Source: OECD / Center for American Progress estimates 3.4× vs Germany
Prior Authorization · The Growing Burden

53 Million Determinations.
Millions of Hours. Zero Patient Value.

MA PRIOR AUTH DETERMINATIONS (MILLIONS) · APPEAL RATE TREND VOLUME 36M 2019 39M 2020 44M 2021 47M 2022 51M 2023 53M 2024 APPEAL RATE 7.5% 2019 8.4% 2020 9.2% 2021 10.3% 2022 11.5% 2024 Sources: AHA 2025 · CMS data · CAQH Index 2024
Manual vs. AI-Powered

The Gap Is Not
Getting Smaller

Today — Manual Payer Operations
  • Claims at $12–$40 each over 4–6 weeks
  • Eligibility checked point-in-time — gaps undetected
  • PA at $40–$50/submission · 11.5% appeal rate
  • FWA detected post-payment — partial recovery
  • 65% of denied claims written off permanently
  • $43B/yr chasing payments already owed
vs
AI-Powered Operations
  • Claims auto-resolved in hours, not weeks
  • Eligibility monitored continuously — changes detected before they hit a claim
  • PA pre-screened before submission — denials prevented, not appealed
  • FWA flagged in real time — before payment leaves the system
  • Denial root causes resolved at source
  • Revenue risk visible in real time — never a month-end surprise
From the Founder · Right Skale
"The $900 billion figure shows up in your denial rate, your days in AR, your prior auth overhead, and the size of your billing team. Every one of those numbers has a different value in an AI-powered operation. The gap between where you are and where you could be is not a technology problem. It is a decision problem."
— Amit Shah, Founder & President, Right Skale Inc.

75% of payers have no AI strategy. They are not saving money by waiting. They are spending it — at a rate of billions per year.