Costs that do not scale with collections
Fixed costs
These are the per-provider, flat operating, and company-level compliance costs that do not move with collections. They’re modelled flat or per-provider — and the company-level lines are expressed as a plain percent of collections, never a fake “per $1M.” Watch how the flat costs are punishing at low collections and trend toward trivial as the book scales.
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Group A — per-provider & flat operating
Toggle a line on/off to see when to switch it on; edit the amount; the annual column is at the model’s current scale. Per-provider lines are modelled per provider / yr (never per $1M); one-time lines amortize over the contract term.
| Cost line | Amount | Annual @ scale |
|---|
Group B — company-level flat costs
Flat compliance, security and insurance costs — a fixed-cost block, not variable cost-to-collect. Each is a flat $/yr; the table below shows what that flat cost is as a percent of collections at a few scale levels.
| Cost line | Amount | Annual @ scale |
|---|
Flat fixed cost as a percent of collections
The same flat dollars are crushing at $10M collected and a rounding error at $1B.
Explanations & assumptions
Add-ons are out of scope. Any additional services are billed direct to physicians as they opt into them, and are therefore out of scope for this document — opt-in add-ons are pass-through, not part of REV’s cost-to-serve.
SOC 2 Type II is a day-one goal that takes ~12 months to achieve; ONC CEHRT certification likewise — both are assumed as part of the dev/ops build (baked into the dev period), not a separately-toggled go-live line. They appear here so you can size them, with ONC off by default.
Why each line is flat / per-provider (not per $1M)
Content licensing — CPT/ICD-10/HCPCS/SNOMED/LOINC/RxNorm and the drug database (First Databank / Medi-Span, usually the priciest) are seat / enterprise licenses, so cost tracks providers, not dollars collected.
Surescripts eRx + EPCS — a per-prescriber network seat plus EPCS identity-proofing (one-time + annual). Per-transaction eRx already sits in the playground COGS; only the network / identity fees are here.
Interfaces / TEFCA-QHIN / interface engine — a flat platform / per-connection cost to run the engine and QHIN participation; it does not move with collections.
Implementation & onboarding — a one-time per-customer setup cost, amortized over the contract term — fixed per customer, not a percentage of what they later collect.
SOC 2 / HITRUST / ONC CEHRT / pen testing / regulatory counsel / insurance — flat annual program, audit, retainer and premium costs. None scale with collections, so as a percent of collections they are punishing early and trivial at scale.
Disclaimer: pricing is NDA’d and varies by vendor and volume. Every number here is an editable planning estimate, not a quote, and should not be presented as verified pricing.