Rising costs and reimbursement pressure put a squeeze on specialty practices.
New research quantifies four specific ways leaders can implement AI to grow revenue by as much as $125,000 per physician annually: converting missed calls into appointments, bringing patients back for follow-up care, preventing avoidable denials, and recovering patient balances.
NEW YORK, Oct. 13, 2026 /PRNewswire/ -- U.S. dermatology, ophthalmology, gastroenterology, OB-GYN, primary care and orthopedic practices have an estimated $108 billion annual revenue opportunity, according to new research from Prosper AI, a voice AI company that handles both patient calls and insurance payer calls for specialty practices. The analysis identifies four sources of recoverable revenue—missed calls, delayed follow-up care, avoidable claim denials and unpaid patient balances—which together represent approximately $125,000 per physician each year.
Prosper AI's research quantifies how much AI could help recover a practice's revenue. The study found that 1 in 6 of calls to specialty practices go unanswered during office hours, a rate that climbs to 81% after hours. Using AI to answer those calls and optimize how schedules are filled can generate an average of $44,800 per physician in annual revenue. The report also found that only 54% of patients due for a follow-up visit return on schedule. Proactive outreach with the help of AI to bring these patients back sooner can unlock up to $37,400 in additional revenue per physician.
Why are specialty practices under financial pressure in 2027?
Specialty practices are under financial pressure in 2027 because Medicare reimbursements are set to fall while operating costs keep rising. A temporary 2.5% boost in Medicare reimbursements expires at the end of 2026, and the Centers for Medicare & Medicaid Services (CMS) has said it has no plans to renew it. Because commercial health plans benchmark their contract rates against Medicare fee schedules, the impact extends across a practice's payer mix. Meanwhile, 84% of medical groups report higher operating costs than a year ago, with an average increase of 11%, according to MGMA. Adjusted for inflation, Medicare physician payments have declined 33% since 2001, according to the American Medical Association.
Operational complexity also adds to a growing strain. Shifting insurance rules, prior authorizations and scheduling demands stretch staff capacity and create friction for patients. Three in 10 adults say it is difficult to understand what they will owe out of pocket when using their health insurance, according to KFF. Practices have traditionally addressed these burdens by adding administrative staff, an increasingly expensive solution as labor costs rise. The report uncovers how AI can automate administrative work for specialty practices, reducing friction for patients and directly protecting practice revenue.
"Practices are feeling the squeeze from insurers and rising operating costs. They can't control reimbursement rates, but they have more control over growth than they think," said Xavier de Gracia, co-founder and CEO of Prosper AI. "Every unanswered call, every empty appointment slot and every claim denial that could have been prevented represents revenue a practice is leaving on the table. AI is how practice leaders take control of their growth—from getting more patients scheduled and seen to getting paid for the care they deliver. Before deciding what to cut, leaders should understand what is actually in their control to grow."
Key report findings
- Across U.S. dermatology, ophthalmology, gastroenterology, OB-GYN, primary care and orthopedic practices, the revenue gap totals $108 billion annually, impacting individual practices by $125,000 a year per physician, which translates to 11% in annual revenue.
- The $125,000 figure is the sum of four levers: $44,800 from answering calls and filling schedules, $37,400 from bringing patients back for follow-up care, $28,500 from preventing avoidable denials, and $14,100 from recovering patient balances.
- Even during office hours, 1 in 6 calls go unanswered. Using AI to answer calls and optimize how schedules are filled can generate an average of $44,800 per physician in additional annual revenue.
- Only 54 percent of patients due for a follow-up visit return on schedule; 40 percent come back late and 6 percent never return. Proactive outreach with the help of AI to bring these patients back sooner can unlock up to $37,400 in additional revenue per physician.
- Front-end errors, such as billing an inactive insurance plan, skipping a required insurer approval, or misspelling a patient's name, drive nearly half of claim denials. Accurate benefits checks done using AI in advance of a visit can eliminate avoidable denials and translate into an average of $28,500 a year per physician.
- Patients now pay 36 percent of the cost of their care, and nearly 8 percent of what they owe goes unpaid. Outbound AI calls to patients to recover the amount they are responsible for, for care that has been provided, adds up to $14,100 annually per physician.
How does upfront price clarity benefit patients and medical practices?
Upfront price clarity helps patients show up for and pay for their care. It also helps practices fill their schedules with visits they can count on being reimbursed for. When patients know what they'll owe before a visit, a surprise bill is less likely to turn into a no-show or an unpaid balance.
This matters more as affordability concerns grow. According to MGMA, 32% of medical groups reported more no-shows in 2026 than in 2025, while just 10% reported fewer, as affordability concerns grew.
Prosper AI's research points to the benefit-verified appointment as the next step for specialty care. An AI-enabled system confirms the patient's coverage, calculates what the patient will owe and shares that information before the visit. Patients who know their costs upfront are more likely to show up and pay for the care they receive, and practices can fill their schedules with visits they can count on being reimbursed for.
"As a practice leader, you invest a really large portion of your budget in answering the phones, and the call volume still gets overwhelming. Before Prosper, we were getting 28,000 calls a month and only answering about 60% of them," said Noah England, Chief Operating Officer of Piedmont Plastic Surgery and Dermatology, in North Carolina. "With Prosper, we have fewer providers than we did a year ago and more appointments. In August, appointments booked across our 37 providers rose 17% year over year. It sounds simple but the key is that we're just handling every single call. Looking ahead, we see so many more opportunities to grow revenue through things like getting referrals scheduled immediately or helping patients understand what they owe. I want to keep my people concentrating on patients, not paper."
Prosper AI Growth Report FAQ
How much revenue can specialty practices add each year with AI?
Specialty practices can add an estimated $125,000 per physician annually, adding up to $108 billion nationally, based on the number of specialty practices nationwide. The figure spans four controllable operational areas: converting missed calls to appointments, re-engaging existing patients, preventing avoidable denials, and recovering the patient's responsibility.
What causes the most lost revenue in a medical practice?
Unfilled schedules and unanswered calls are the single largest driver of lost revenue, worth $44,800 per physician annually, more than denials and patient collections combined.
What percentage of claim denials come from administrative errors?
Nearly half of claim denials trace back to a preventable administrative error, a misspelled name or an incomplete registration field, rather than a clinical dispute or a coverage exclusion. The administrative error, not the claim itself, is the point of failure.
How can a practice reduce missed appointments and fill their schedules?
Only 54% of patients due for a follow-up visit come back on schedule Proactive re-engagement of lapsed and overdue patients addresses that gap directly, representing an estimated $37,400 per physician annually.
About the Research
Prosper AI leveraged data from interactions across patients and insurance companies accounting for more than $3 billion in care managed, and combined that data set with specialty-specific data from the Medical Group Management Association (MGMA). Prosper then conducted CallIQ, an original phone-access study that attempted to reach about 2,000 practices across 29 states in six specialties: dermatology, ophthalmology, gastroenterology, OB-GYN, primary care and orthopedics. For every call, the study tracked how long it took for a live person to answer and how long it took to begin scheduling. No appointments were booked. The report also draws on federal health data from CMS, AHRQ and CDC and on peer-reviewed studies of follow-up adherence, claim denials and patient responsibility. Source: 2026 MGMA DataDive Financials and Operations. Used with permission from MGMA.
Get the Report
The full report, including specialty benchmarks and a framework practice leaders can use to calculate their own revenue gap, is available on Prosper AI's website. Practice leaders can also explore the interactive revenue growth calculator and read the top five takeaways from the report.
About Prosper AI
Prosper AI is the patient access platform that helps exceptional specialty practices grow. Its AI workforce connects patient access and reimbursement across the front and back office—from scheduling and patient outreach to benefits verification, prior authorization, claims follow-up and patient billing.
