The 2026 Medical Billing Benchmark Report

Four numbers shape the economics of running an independent practice right now: how often claims get denied, how much prior authorization slows care and cash, how clean a high-performing billing operation keeps its claims, and how long money sits in accounts receivable. This page pulls the most current published figure for each, with full citations. Every number here comes from a third party, Kodiak Solutions, the American Medical Association, HFMA, and MGMA. None of it is Sterling data; we are a medical billing company and we compiled it because our clients and prospects ask for it.

1. Hospital claim denial rate: 11.6% and rising

The average initial claim denial rate across roughly 2,300 hospitals rose to 11.6% in 2025, up from 11.4% in 2024 and 11.5% in 2023. Prior-authorization and medical-necessity denials, the categories Kodiak calls "clinical," accounted for nearly all of the increase. Across the same hospital base, provider organizations lost a combined more than $48 billion to final denials and bad debt in 2025, a 25% jump year over year, with the median hospital final denial rate climbing from 2.5% to 2.7%.

Source: Kodiak Solutions, analysis of Kodiak Platform and Kodiak Revenue Cycle Analytics data covering ~2,300 hospitals and 350,000 physicians, reported March 31, 2026. Press release · kodiaksolutions.com

2. Prior authorization: 95% of physicians say it delays care

In the AMA's 2025 nationwide survey of 1,000 practicing physicians, 95% said prior authorization delays access to necessary care, and 79% said it leads patients to abandon treatment altogether. More than one in four (26%) reported that a prior-authorization delay had led to a serious adverse event for a patient. Only one in three physicians believed the latest round of insurer reform pledges would make a meaningful difference.

Source: American Medical Association, 2025 Prior Authorization Physician Survey (fielded December 2025; released May 13, 2026). Survey page · Full results (PDF)

3. Clean claim rate: 95%+ is the high-performer bar

HFMA's MAP Keys, the industry-standard set of 29 revenue-cycle KPIs, define the clean claim rate as the share of claims that pass every edit without manual intervention. High-performing revenue cycles are widely benchmarked at 95% or better; a number of RCM analyses cite 98% as best-in-class. A typical hospital clean claim rate sits in the 75% to 85% range. Every point below the benchmark is a claim reworked by hand, and cash that arrives weeks later than it should.

Source: Healthcare Financial Management Association, MAP Keys / MAP Initiative. hfma.org MAP Keys

4. Days in accounts receivable: 36 vs 47

MGMA's 2024 Cost and Revenue Survey puts better-performing physician practices at about 36 days in accounts receivable, against a median of 47. HFMA considers 30 to 40 days a healthy range. The 11-day gap between the median and the better-performer benchmark is money a practice has already earned, sitting in a worklist instead of the bank.

Source: Medical Group Management Association, 2024 Cost and Revenue Survey / MGMA DataDive; HFMA days-in-A/R benchmarks. mgma.com data reports

Methodology and updates

Every figure on this page is taken directly from the third-party publication cited beneath it. Sterling Global Solution did not conduct primary research and does not adjust or reweight the source data. Each number reflects the most recent full-year figure published as of August 2026. When Kodiak, the AMA, HFMA, or MGMA release newer data, this page is updated and the "Reviewed against source data" date at the top is changed.

Full source list

Kodiak Solutions. "Healthcare Provider Organizations Saw Net Revenue Losses From Final Denials and Bad Debt Grow by 25% in 2025." Business Wire, March 31, 2026. businesswire.com

American Medical Association. "2025 AMA Prior Authorization Physician Survey." Released May 13, 2026. ama-assn.org · Full PDF

Healthcare Financial Management Association. "MAP Keys, Industry-standard revenue cycle KPIs." hfma.org

Medical Group Management Association. "2024 Cost and Revenue Survey" / MGMA DataDive. mgma.com