A · Immediate repayment
Repay now
Pay the principal immediately; avoid future estimated interest.
- ↳ Certain payment · 100%
- Total cost $100,000.00
Amount paid now
$100,000.00
Arclight Audit & Appeals · Decision tools
Medicare Audit Appeal
Decision Calculator
An overpayment demand raises a practical question: what might each path cost your practice? Adjust the assumptions to explore interest, appeal fees, and the expected value you retain.
Explore your scenario ↓Educational scenarios only. This tool does not assess case merits or predict a judge’s decision. Probability descriptions and pricing illustrations are hypothetical.
Build your scenario
$1–$100 million. Commas and cents are accepted.
Annual percentage; 10% is a planning assumption.
Planning timeline estimate; not a minimum or guaranteed timeline.
Assumed probability of full relief by the end of the appeal through ALJ, based on documentation and quality of your representation.
Mixed scenario; meaningful evidence with substantial uncertainty.
These are hypothetical scenario descriptions, not validated probability estimates. Buying junior, experienced, or specialized support does not establish a success rate.
For a more custom estimate, please reach out to info@arclightaction.com.
Enter the total fixed fee for all appeal levels through ALJ, including redetermination, Qualified Independent Contractor (QIC) reconsideration, and Administrative Law Judge (ALJ) representation. The fee is paid whether the appeal wins or loses. This is not an Arclight quote. Use fees or quotes you’ve received elsewhere to see the value to you.
A second appeal service, separate from repaying now. Both appeals use the same interest rate and resolution period.
What could you save by appealing?
- Demand principal
- $100,000.00
- Estimated simple interest
- $6,666.67
- Projected balance at resolution
- $106,666.67
Your estimated savings
$39,166.67
After your appeal fee, compared with paying the demand now. The estimate accounts for both winning and losing using the chance of winning you selected.
Under these assumptions, appealing comes out ahead on average.
How much could you pay and still come out ahead?
- Your appeal fee
- $7,500.00
- Break-even fee
- $46,666.67
This is not an Arclight Action quote.
At the break-even fee, your estimated savings are $0. Pay less and the difference stays with you; pay more and, under these assumptions, it makes more financial sense to repay the demand. This is a scenario calculation, not a quote or a market price.
Bring the scenario to a free review
Documentation, the appeal stage, and the specific issues matter. Request a free review to discuss your situation.
No contact details are needed to use this calculator. Sharing the scenario is optional.
Three paths. Different financial outcomes.
Start with a $100,000.00 demand. The appeal fee is paid whether you win or lose. Each branch shows what that outcome could cost after 8 months.
Win probabilities are assumptions, not predictions. A full loss includes the demand, estimated interest, and appeal fee.
Decision at demand
B · Alternative appeal
Add another appeal service
Enable the comparison to model a second fee and assumed probability. This is a separate appeal option.
C · Appeal option
Proposed appeal service
Appeal service fee
$7,500.00
Fixed fee, paid whether you win or lose
This is not an Arclight Action quote.
- ↳ If you win in full · 50%
- Appeal fee only: $7,500.00
- Demand and estimated interest eliminated.
- ↳ If you lose in full · 50%
- Total payable: $114,166.67
- Demand + estimated interest + appeal fee.
Compare the economics
| Total cost / value | A · Repay now | C · Proposed appeal |
|---|---|---|
| Appeal service fee | $0.00 | $7,500.00 |
| If you win in full | $100,000.00 | $7,500.00 |
| If you lose in full | $100,000.00 | $114,166.67 |
| Estimated savings vs. paying now | $0.00 | $39,166.67 |
Win and loss amounts include the appeal fee. Repaying now has one certain cost. Estimated savings account for both outcomes; actual results may differ.
See the calculation
For this comparison, we combine what you would pay if you win with what you would pay if you lose, using your selected chance of each outcome. The figures below are averages for planning, not appeal fees or bills you would receive.
- Repay now
- $100,000.00
- Proposed appeal: average scenario cost
- $60,833.33
About these estimates
These figures help you compare options using your own assumptions. Your actual costs depend on the outcome of your appeal.
How the estimates are calculated
Estimated simple interest = demand × annual rate × months ÷ 12. The projected balance adds that interest to the demand. Expected appeal cost = fixed fee + probability of full loss × projected balance. Expected savings subtract that cost from the demand paid today.
The fee ceiling versus repaying now is demand − probability of full loss × projected balance. With another appeal service, its fee + probability difference × projected balance gives a second ceiling. The relevant ceiling is the lower of the two, so the proposed fee must leave value against both comparisons.
Assumptions and Limitations
- Full relief eliminates the entire modeled demand and associated interest. Full loss leaves the entire balance payable.
- The service fee is fixed and paid whether the appeal wins or loses.
- No partial relief, intervening repayments, recoupment, additional expenses, later appeals, discounting, or separate financing costs.
- Both appeal services use the same interest rate and time to resolution. Actual cash flows may differ.
- Interest and timeline are editable planning assumptions. They do not establish the applicable Medicare rate, accrual rules, or case timeline.
- Scenario probabilities are hypothetical. This calculator does not determine actual case merits or predict an individual judge’s decision.
- Calculations retain exact decimal values until display. Displayed amounts round to the nearest cent; small rounding differences between displayed components can occur.