American Billing Association — Industry Research

2026 Medical Billing & RCM Benchmark Report

Published July 2026  |  Data sources: MGMA, HFMA, CMS, Kodiak Solutions, Experian Health, KFF, AMA, MD Clarity  |  americanbillingassociation.com

This report compiles verified benchmark data from the leading healthcare revenue cycle research organizations. Use it to compare your practice's performance against industry averages, top quartile, and best-in-class thresholds across the metrics that matter most to your bottom line.

11.8%
Industry Avg Denial Rate (up 15.7% since 2020)
$262B
Claims denied annually in the US (HFMA)
85–90%
Claims preventable before denial
$48.4B
Net revenue lost to denials in 2025 (up 25% YoY)
1. Days in AR by Specialty

MGMA establishes ≤40 days as the standard benchmark for most physician practices. Best-in-class is ≤30 days. Alert threshold: >50 days signals systemic AR management failure.

SpecialtyIndustry AvgTop QuartileTop 10%Primary Variance Driver
Primary Care / Family Medicine30–38 days25–30 days<22 daysHigh volume, lower complexity
Cardiology35–45 days28–35 days<28 daysPrior auth for imaging/procedures
Orthopedics38–48 days30–38 days<30 daysSurgical auth, implant billing
Behavioral Health40–55 days30–40 days<30 daysPayer credentialing gaps, auth burden
DME45–65 days35–45 days<35 daysHCPCS coding, medical necessity docs
Pain Management38–50 days28–38 days<28 daysControlled substance audit risk, modifiers
OB/GYN32–42 days25–32 days<25 daysGlobal billing periods, mixed payer
Neurology38–50 days30–38 days<28 daysNeurodiagnostic coding complexity
Oncology40–55 days30–40 days<30 daysDrug infusion prior auth, high-cost claims
Dental (medical crossover)35–50 days28–38 days<28 daysMedical necessity documentation

Sources: Revenue Synergy 2026 Specialty Benchmarks; MGMA Cost and Revenue Glossary; MD Clarity RCM Metrics Database

2. Clean Claim Rate Benchmarks

A clean claim passes all edits and is accepted for adjudication on first submission. The HFMA MAP target is 95%. 68% of providers say clean claim submission is harder in 2025 than the prior year (Experian Health 2025 State of Claims, n=250 RCM leaders).

Overall industry benchmarks: Industry average 85–90%  |  HFMA MAP target: 95%  |  Top quartile: 95–97%  |  Top 10% / best-in-class: 98–99%+
SpecialtyIndustry AvgTop QuartileTop 10%
Primary Care92–95%96–97%98%+
Cardiology90–94%95–96%97%+
Orthopedics89–93%95–96%97%+
Behavioral Health88–92%94–95%96%+
Pain Management88–93%95–96%97%+
Oncology87–92%94–95%96%+
Radiology91–95%96–97%98%+
OB/GYN91–94%95–96%97%+
Neurology89–93%95–96%97%+
DME85–90%92–94%96%+

Sources: Revenue Synergy 2026; HFMA MAP Keys; Experian Health 2025 State of Claims

3. Denial Rate Benchmarks
Industry average initial denial rate: 11.8% (Kodiak Solutions 2024, 300,000+ physician dataset) — up from 10.2% in 2020, a 15.7% increase in four years. HFMA MAP target: <5%. Best-in-class: <3%.
By Payer Type
PayerInitial Denial RateFinal Denial Rate (Post-Appeal)Notes
Medicare FFS7.38% improper payment rate~2–3%CMS FY2024 Improper Payments data
Medicare Advantage15.7%~6.7% (57% overturned on appeal)KFF 2024 MA Data; AI-driven denials rising
Medicaid (FFS & MCO)16.7%~6% (44% overturned)Aptarro 2026
ACA Marketplace19–20%~8–10%9-year high (KFF 2023)
Commercial/Private13.9–15%~3% finalRose from 8% to 11%+ (2021–2023)
By Specialty
SpecialtyAvg Denial RateTop Quartile TargetTop 10% Target
Primary Care7–10%<5%<3%
Cardiology10–13%<6%<4%
Orthopedics12–15%<7%<5%
Behavioral Health15–18%<8%<6%
Oncology13–18%<7%<5%
Pain Management12–16%<7%<5%
Neurology10–14%<6%<4%
OB/GYN8–12%<5%<3%
Radiology/Imaging12–14%<6%<4%
DME14–20%<9%<6%

Sources: Kodiak Solutions 2024 RCM Analytics; O STAFF Solutions 2025; Aptarro 2026; KFF 2024

4. Net Collection Rate by Specialty

Net Collection Rate = Payments ÷ (Charges − Contractual Adjustments). This is the single most important billing KPI — it shows what percentage of what you're owed actually gets collected. Alert: below 90% signals significant revenue leakage.

SpecialtyIndustry AvgTop QuartileTop 10%Key Notes
Primary Care94–96%96–97%97%+Straightforward coding boosts rate
Cardiology93–95%96–97%97%+Procedure mix drives variance
Orthopedics92–95%95–97%97%+Implant write-offs drag average down
Behavioral Health88–93%94–95%96%+High self-pay + no-show leakage
OB/GYN93–95%96–97%97%+Global period management critical
Neurology90–94%95–96%97%+Neurodiagnostic complexity
Oncology90–94%95–96%97%+Drug infusion complexity
Pain Management90–94%95–96%97%+High-risk code audit exposure
DME85–90%92–94%96%+Highest leakage specialty

Sources: MGMA DataDive Cost & Revenue; Medical Billers and Coders 2024; Revenue Synergy 2026

5. Cost-to-Collect Benchmarks
Billing ModelSmall Practice (<3 providers)Mid-Size (4–10 providers)Large Group (10+ providers)
In-House (fully loaded)10–15%7–10%5–8%
Outsourced6–9%5–7%3–5%
Outsourced (complex specialty)8–12%7–9%5–7%
HFMA guidance: Alert level is >5% of net patient revenue for cost-to-collect. In-house billing at a small practice typically runs 10–15% when fully loaded (salary + benefits + software + clearinghouse + training + compliance + office space = $72,000–$115,000 per FTE annually).

Sources: Best Medical Billing 2025; Neolytix 2026; MBW RCM 2024; Optivate Health 2024; 247 Medical Billing Services

6. AR Aging & First-Pass Resolution Rate
KPIIndustry AverageMGMA/HFMA TargetTop QuartileTop 10%
AR >120 Days (% of total AR)12–15%<10%<8%<5%
AR >60 Days (% of total AR)25–35%<25%<20%<15%
First-Pass Resolution Rate82–87%90%+93–95%95–98%
Financial reality: Claims beyond 120 days have <50% probability of collection (MD Clarity). Reworking a denied claim costs $25–$118 per claim in staff time (HFMA). A practice with 1,000 claims/month at 85% FPRR pays to rework 150 claims/month — at $50 average rework cost, that's $7,500/month in pure administrative waste.
7. Top Denial Reason Codes
CARC CodeDescriptionFrequencyPrevention
CO-16Missing/incomplete/invalid information#1 most common — 26% of denialsPre-submission claim scrubber; demographic verification
CO-4Modifier invalid for procedure billedTop 5; high in surgical specialtiesModifier rules engine; coder training on -25, -59, -51
CO-97Payment included in allowance for another serviceTop 3; high in cardiology, surgeryCCI edit check; NCCI bundling awareness
CO-22COB issue — coordination of benefitsSignificant in dual-coverage patientsCOB verification at eligibility check
CO-11Diagnosis inconsistent with procedureCommon in behavioral health, orthoICD-10 specificity; LCD/NCD alignment
CO-50Not deemed medically necessaryGrowing — affects MA heavilyMedical necessity documentation; LCD adherence
CO-29Timely filing deadline exceeded~5% of all denials — 100% preventableAutomated filing deadline tracking by payer
CO-109Claim not covered by this payerFront-end eligibility failureReal-time eligibility verification
Prior authorization as denial root cause: 20–25% of all denials trace to missing or invalid prior authorization. PA-related denials have grown >20% in two years. Physicians now average 39 PA requests/week, 13 hours/week on PA administration (AMA 2025 Prior Authorization Physician Survey).
8. 2025–2026 Trend: What Got Worse & What Got Better
▲ GOT WORSE
  • Overall denial rate hit 11.8% — up 15.7% since 2020 (Kodiak 2024)
  • Medicare Advantage denials up 4.8% YoY; now 15.7% initial (KFF 2024)
  • ACA Marketplace denials at 9-year high: 19–20%
  • Physicians average 39 PA requests/week (+20% in 2 years)
  • AI-driven payer denials: 50–75% auto-deny rates on certain categories
  • Net revenue leakage from denials up 25%: $38.6B → $48.4B
  • 68% of providers say clean claim submission is harder than prior year
▼ GOT BETTER
  • AI adoption: 14% of providers using AI for claims; 69% report reduced denials
  • 17% of medical groups now have >60% of RCM operations automated
  • Appeal success strong: 57% of MA denials overturned; 60–80% in some Medicaid
  • 41% of providers upgraded claims management technology in 2024
  • Electronic clean claims: Medicare pays in 14 days vs. 29 days for paper
  • AI-driven RCM reduced denial rates by 27% for early adopters (Black Book 2023)
9. Payer Processing Performance
PayerAvg Processing TimeInitial Denial RateTimely Filing Window
Medicare FFS14 days (electronic), 29 days (paper)7.38%365 days from DOS
Medicare Advantage14–30 days (varies)15.7%365 days (most plans)
Medicaid FFS30–45 days (state-dependent)16.7%90 days–12 months (state-dependent)
UnitedHealthcare15–30 days13–17%90–180 days commercial
Aetna15–30 days12–16%120 days most commercial
Cigna15–30 days11–15%90–180 days
Humana14–28 days12–16%90 days (strictest major payer)
BCBS (varies by state)15–30 days10–14%60 days (WY) to 2 years (AL) — verify by state

Sources: CMS MLN Matters MM3557; KFF 2024 MA Data; Aptarro 2026; HFMA 2025; BellMedEx Timely Filing Guide

Data Sources: MGMA 2024 ACMPE Cost and Revenue Survey; HFMA MAP Keys and Pulse Survey; CMS FY2024 Improper Payments Fact Sheet; Experian Health 2025 State of Claims Report (n=250 RCM leaders); AMA 2025 Prior Authorization Physician Survey; Kodiak Solutions 2024 RCM Analytics (300,000+ physician dataset); KFF 2024 Medicare Advantage Prior Authorization Data; Aptarro 2026 Healthcare Denial Statistics; Revenue Synergy 2026 Medical Billing Benchmarks; MD Clarity RCM Metrics Database; Black Book Market Research 2023; Deloitte Center for Health Solutions 2024.

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