Medical Billing Benchmarks 2026

The 2026 benchmarks, with their populations named

Each row below states what was measured, on whom, and by whom. The population column is not a footnote — it is the difference between a benchmark that applies to you and one that does not.

Why published denial rates disagree with each other

Three separate things get called “the denial rate”, and mixing them produces the spread you see in most published comparisons.

1. Different populations. Hospital claims and physician-practice claims deny at different rates, for different reasons. A hospital figure applied to a five-physician practice describes nothing about that practice.
2. Different denominators. Optum counts claim remits. MGMA counts claims denied on first submission. AAFP’s target names no denominator at all. A dollar-based rate and a count-based rate are not comparable even within one organization.
3. Different sides of the transaction. KFF’s 19% is what insurers denied, reported by insurers under federal transparency rules. It is not what a provider experienced filing claims.

Hospital data is not physician-practice data

The physician-practice number is the lower one. MGMA puts claims denied on first submission at 8%, and notes the same rate in 2019. Hospital initial denial rates run 11.81% to 12%. A page that tells a practice owner their peers deny at 12% is quoting hospital data at them.

This matters beyond accuracy. A practice benchmarking itself against a hospital figure will conclude it is performing well at 10% when its actual peer group sits at 8% — and will leave the difference uninvestigated.

What actually causes denials

Registration and eligibility is the largest single cause at 24%, and has held that position for four consecutive years. Together with claim-data errors and authorization, front-end causes account for 44% of all denials — failures that happen before a coder touches the claim.

This is hospital data. No free source publishes an equivalent cause breakdown for physician practices; the closest is an MGMA Stat poll of 288 group leaders in January 2026, in which 48% named denials and appeals as their biggest revenue-cycle leak and 23% named front-end issues — a perception measure, not a claim measurement. Reducing front-end denials is what eligibility verification and prior authorization support exist to do.

A/R and collection benchmarks

The targets below are guidance ranges published by AAFP, not measured medians. We cite AAFP directly because the versions of these numbers circulating as “HFMA benchmarks” are not HFMA research — see the methodology section.

Measure your own against these with the collection rate calculator and the denial rate calculator.

What no free source publishes

Stating the gaps is part of the report. Each of these is routinely published elsewhere as a confident number; none of them could be traced to a free primary source.

• Observed median days in A/R for physician practices. MGMA collects it; the medians sit inside licensed DataDive products. AAFP publishes a target (below 50 days at minimum, 30–40 preferable), not a measurement.
• Observed net collection rate median. Does not exist free. AAFP publishes an adjusted collection rate target of 95% minimum, 95–99% average.
• Clean claim rate target. The ubiquitous 98% traces to vendor-sponsored content citing a trade publication. No methodology at any link in the chain.
• Denial rates by specialty. Every source offering them is a billing-company blog citing nothing. We publish none.
• Denial-code frequency rankings. No authoritative CARC-level frequency data exists — X12 publishes no usage statistics and neither does CMS. See the denial code database.
• Benchmarks by practice size. Not published free by anyone for denial or A/R metrics.

Methodology, sample sizes and limitations

What this report is. A compilation of publicly published figures, not original research. MedPrecision did not survey practices and does not publish client data. Every figure was fetched from its primary source on July 28, 2026 and then independently re-fetched by a second pass instructed to refute it; figures that could not be confirmed verbatim were dropped rather than softened.

What we corrected. The “98% clean claim rate”, “97–99% net collection rate” and “A/R over 90 days below 10%” figures widely attributed to HFMA trace to a single article on hfma.org carrying a “Sponsored by Conifer Health Solutions” disclosure. That article attributes its own figures to AAFP, and its clean-claim figure to Becker’s ASC Review. HFMA MAP Keys publishes metric definitions and equations, not target values. We cite AAFP directly and state the clean claim rate as unavailable.

Limitations. Several key sources are vendor research (Optum, Kodiak, Experian, Tebra) whose client bases are self-selected and not representative samples. Kodiak’s two releases disagree on the 2024 final denial rate (2.8% vs a 2.5% median) and publish no reconciling formula — both are reported here. Some figures are several years old because no newer free equivalent exists. MGMA’s richest data is licensed and could not be used.