Super deep dive — TCO & net revenue to the practice

EMR/RCM deep dive

A practice does not buy software — it buys money kept. So only two numbers decide the winner: the all-in cost to run (TCO) and the net revenue that actually lands in the bank. REV wins both — not by shaving a license fee, but by collecting more of what the practice earns.

TCO and final revenue to the practice are all that matter. Every rival can quote a low sticker price. None of them keep the money. Once you model revenue leakage — claims under-coded, denials never worked, AR left to age — the cheap-looking EMR quietly loses 5–11% of collections. REV's AI codes to the right specificity and works every denial automatically, so it both costs the least to run and banks the most.

These are at-scale figures the model earns as it learns. Year 1 runs below ~$750K collections per provider and ramps toward the ~$1,071,000/provider at-scale level as the system improves — the net and TCO above are the steady-state target; capture and margin build over time, not switched on day one.

Computing the model…

How we grow: acquire physician networks, not one doctor at a time

REV doesn't sell one clinic at a time. ~85% of growth is captive — Empower and partner networks acquire physician practices and place them on REV, which simply onboards them at ~$0 CAC. A lean external team only has to win the ~15% we don't already own, working network-level deals that put dozens of practices on the platform at once. Fast provider ramp, self-funded on $4M. See the growth engine →

The only two numbers: all-in TCO & net to the practice

Per provider per month. REV is pinned on top and highlighted. Click any vendor to expand the full breakdown — software, RCM model, capture rate, and where the leakage comes from. Sort by Net (default) or TCO. Competitor names are withheld; figures are modeled, not vendor quotes.

Vendor · headline totals	All-in TCO	Net to practice	Capture

Looking for the simpler sticker-price view? See the all-in EMR comparison. This page goes deeper: it nets out revenue leakage to show money actually kept.

See the coding analysis — the primary-care E/M distribution behind REV's capture and margin.

Methodology — every assumption, in the open

Investors should scrutinize this. The model is deliberately conservative and applies the same rules to every vendor — the only thing that moves the result is how well each RCM model captures revenue.

1. Gross potential collections. We assume $89,250 in gross potential collections per provider per month ($1,071,000/yr) — REV's real proforma assumption of $150 collected per encounter × 595 encounters/provider/mo. It is a labeled assumption, identical for every vendor, so it never tilts the comparison.

2. Realized collections = gross × capture rate. No practice collects 100%. Capture is reduced by two kinds of revenue leakage: (a) miscoding / undercoding — visits billed below the level of service actually delivered; and (b) denials not worked + slow / aging AR — claims that bounce and never get re-worked, or sit until timely-filing limits kill them.

3. Capture is set per RCM model, not per vendor. A turn-key AI cycle leaks far less than a hand-off to a 3rd-party biller or a DIY billing desk. The five profiles are shown in the table below — assumptions are explicit and applied uniformly. REV's 98.5% capture (1.5% leakage) is a modeled at-scale target, not a contradiction of the market: the industry's own data shows independent practices lose a well-documented 5–10% of collections to miscoding and unworked denials. Closing that gap is precisely what REV is built to do — ambient-AI coding to documentation-supported specificity, automated denial/appeal generation, and continuous AR — driving leakage down toward ~1.5%. The leakage is the problem; REV is the solution to it.

4. TCO = software + revenue-cycle cost. Software = base subscription + the ambient-AI add-on (included for REV). Revenue-cycle cost = the vendor's RCM % of realized collections plus the in-house billing labor each model forces on the practice. REV TCO = $3,980 = $595 software + 4.9% of realized collections, fully managed, zero in-house billers.

5. Net revenue to practice = realized collections − TCO. This is the number that matters. REV nets $65,094/provider/mo at a 98.5% capture rate — the highest net and the lowest TCO of all 32 platforms. We also report it annualized (× 12) and across a typical 2.5-provider practice.

Capture & cost by RCM model

RCM model	Miscoding leak	Denials / AR leak	Capture	Revenue-cycle cost	In-house billing burden
REV — turn-key, AI	0.5%	1.0%	98.5%	4.9% flat	None — fully managed
Bundled (co-sourced)	2.0%	3.0%	95.0%	vendor % + 1.5%	You staff exceptions
Separate RCM service	2.5%	4.5%	93.0%	vendor % + 2.5%	Contract + oversight + AR
3rd-party partner	3.0%	6.0%	91.0%	vendor % + 3.5%	Hire a coordinator
None — bring your own	3.5%	7.0%	89.5%	8.0% flat (in-house shop)	Run your own billing team

The "vendor %" is the midpoint of each platform's published / estimated RCM range. The overhead added on top reflects the real in-house labor each model leaves with the practice — the cost that never shows up on a sticker price.

Where the money leaks — area by area

Ambient AI scribe

On every rival it's a paid add-on (~$125–249/provider/mo, usually quote-only). REV includes it — and uses the same model to drive coding accuracy, so the scribe pays for itself in capture, not just clicks saved.

Coding accuracy

Manual / rules-based coding under-codes to play it safe, leaving 2–3.5% of legitimate revenue on the table. REV codes each encounter accurately to documentation-supported specificity — miscoding leak modeled at just 0.5%. PCP visit mix is concentrated in routine established-patient E/M (mostly 99213/99214), so the coding surface is narrow and low-risk with documentation safeguards — accurate capture of work already performed, explicitly not aggressive upcoding.

Denials & AR

Denials that aren't re-worked, and AR that ages past timely-filing, are pure lost revenue — 3–7% in leak-prone models. REV auto-generates appeals and works AR continuously (1.0% leak).

Scheduling

Per-minute resource-graph scheduling fills the day more completely than fixed slots — more billable encounters from the same provider hours. Bolt-on schedulers on rivals don't optimize utilization.

The in-house biller

"Cheap" EMRs assume you hire your own billing staff or manage a 3rd party — a real cost that never appears on the quote. REV needs zero in-house billing headcount.

Hidden / extra costs

Interface fees, Direct-messaging fees, database licenses, data-extraction fees on exit — common on incumbents, surfaced only on the MSA. REV is one published, all-inclusive price.

Explainers (founder-only — add video IDs before exposing)

Short primers on the mechanics behind the model. Replace the placeholders below with final video IDs before sharing.

Placeholder — embed an explainer on revenue leakage in RCM.
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Why practices lose 5–11% of collections

The miscoding + unworked-denials leakage this model is built on.

Placeholder — embed an explainer on denials & AR management.
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Denials, appeals & aging AR

What "working denials" actually means — and what it costs when no one does.

Placeholder — embed an ambient AI scribe walkthrough.
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Ambient AI in a real encounter

Add-on everywhere else; included — and coding-aware — in REV.

Placeholder — embed a TCO of an EMR explainer.
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True cost of ownership

Why sticker price ≠ what the practice actually pays to run.

Disclaimer: the gross-collections baseline, capture rates and leakage percentages are modeled, conservative planning assumptions applied uniformly by RCM model — not audited results. Competitor pricing is grounded in published rate cards and real vendor quotes / MSAs where available (e.g. NextGen quoted ~$1,020/provider/mo, Jun 2026) and modeled from published ranges otherwise; the ambient-AI add-on is modeled at a typical ~$125–249/provider/mo where a vendor doesn't publish one, flagged as an estimate. Names are withheld. REV figures use its published, all-inclusive rates. Append ?realnames on the sister comparison page to reveal vendor names.

Market structure — a fragmented field

Beyond TCO, the other half of the story: no vendor owns the small independent practice. Top 3 ~40%; a long tail of 30+ smaller vendors splits ~38%. Est. PCPs per vendor on a ~280,000 US-PCP base.

REV's plan of ~866 providers is ~0.3% of US PCPs / ~1% of the long tail — and the 2026–27 FHIR mandates push these fragmented practices to switch. Ranks 11+ are estimates (Definitive publishes only the top 10); REV is pre-launch and not shown.