Medical Billing Statistics 2026: The Numbers Every Practice Should Know

Medical billing is getting harder, not easier. Denials are climbing, prior authorizations eat hours every week, and payers are slower to pay. This page collects the most useful medical billing statistics for 2026 in one place. Every number links to the original source, so you can check it and quote it.

Key medical billing statistics at a glance

Statistic	Figure	Source
US national health spending (2024)	$5.3 trillion, 18.0% of GDP	CMS
Physician and clinical services spending (2024)	$1,109.7 billion, up 8.1%	CMS
Providers with denial rates of 10% or higher	41%	Experian Health, 2025
Top cause of denials: missing or inaccurate data	50% of providers	Experian Health, 2025
Claims denied on first submission (single-specialty)	8%	MGMA
In-network claims denied by HealthCare.gov insurers (2023)	20%	KFF
Prior authorizations per physician, per week	39	AMA
Hours per week spent on prior auth	13	AMA
Annual cost of routine admin tasks	$90 billion	CAQH Index

US health spending: the size of the revenue at stake

The money flowing through medical billing keeps growing. According to the CMS National Health Expenditure fact sheet:

• National health spending grew 7.2% to $5.3 trillion in 2024, or $15,474 per person, and reached 18.0% of GDP.
• Physician and clinical services spending grew 8.1% to $1,109.7 billion.
• Medicare spending grew 7.8% to $1,118.0 billion (21% of total), Medicaid grew 6.6% to $931.7 billion (18%), and private health insurance grew 8.8% to $1,644.6 billion (31%).
• Out-of-pocket spending reached $556.6 billion, 11% of the total.
• CMS projects health spending will rise from 18.0% of GDP in 2024 to 20.6% by 2034, with physician and clinical services growing about 5.5% per year.

What it means for practices: more dollars, more payers and more patient balances to collect. A small leak in your billing process gets bigger every year.

Claim denial statistics

Denials are the single biggest drain on practice revenue, and the trend is moving the wrong way.

From the Experian Health 2025 State of Claims survey of 250 healthcare finance and billing leaders:

• 41% of providers face denial rates of 10% or higher, a share that has grown every year since 2022.
• 54% say claim errors are increasing.
• 68% say submitting clean claims is harder than a year ago.
• 43% report being understaffed.
• 90% of denied claims get at least some human review before resubmission.
• The top three denial causes: missing or inaccurate data (50%), authorizations (35%) and incomplete or inaccurate patient registration (32%).

From MGMA:

• MGMA DataDive data showed a single-specialty aggregate rate of 8% of claims denied on first submission.
• In a March 2024 MGMA Stat poll, 60% of medical group leaders said their denial rates had increased compared with the year before; 29% said they were unchanged and only 11% saw a decrease.
• Common reasons included insufficient documentation, eligibility or wrong ID numbers, untimely filing and incorrect modifier use, especially modifier 25.
• MGMA also reported that payment on a clean claim from a Medicare Advantage plan typically takes 30 to 45 days, compared with 10 to 14 days for traditional Medicare.

From KFF's analysis of CMS data on HealthCare.gov plans:

• Insurers denied 20% of in-network claims and 36% of out-of-network claims in 2023.
• In-network denial rates ranged from 1% to 54% depending on the insurer.
• By state, average in-network denial rates ranged from 6% (South Dakota) to 34% (Alabama).
• Fewer than 1% of denied claims were appealed, and insurers upheld 56% of the appeals they received.

What it means for practices: most denials start at the front desk (eligibility, registration and authorization), and most are never appealed. A denial process that checks eligibility before the visit and appeals every recoverable claim is worth real money.

Prior authorization statistics

Prior authorization is now a daily workload, not an exception. The AMA's survey of 1,000 physicians found:

• Practices complete an average of 39 prior authorization requests per physician, per week.
• Physicians and staff spend about 13 hours a week on them.
• 40% of physicians have staff who work exclusively on prior authorizations.
• 89% say prior authorization somewhat or significantly increases burnout.

The same AMA article cites a KFF analysis of CMS data showing that in 2023:

• Medicare Advantage insurers received more than 50 million prior authorization requests and partially or fully denied 3.2 million.
• Only 11.7% of those denials were appealed, but 81.7% of appealed denials were fully or partially overturned.

What it means for practices: appealing pays. When more than four out of five appealed Medicare Advantage denials get overturned, skipping appeals leaves money on the table.

Administrative cost and automation statistics

The 2024 CAQH Index, built on data from more than 600 provider organizations and health plans, found:

• Routine administrative tasks such as checking insurance cost the industry $90 billion a year.
• Moving from manual to electronic workflows is a $20 billion savings opportunity.
• Fully automated workflows save an average of 70 minutes per patient visit.

Adoption is still slow. In the Experian Health 2025 survey, 67% of providers said AI can improve the claims process, but only 14% were using it. Of those using it, 69% said it reduced denials or improved resubmission success. Only 56% said their current technology is enough for revenue cycle demands, down from 77% in 2022.

An MGMA Stat poll also found that most group practices have 40% or less of their revenue cycle operations automated.

Medical billing cost statistics

What does outsourced billing cost? There is no audited national average, so treat these as market ranges:

• For dental, published outsourced billing prices from eAssist run $1,400 per month under $40,000 in monthly insurance collections, then 3.5% from $40,000 to $100,000, stepping down for larger offices (eAssist pricing).

Tip: always ask whether the percentage is charged on net collections (money actually received) or on billed charges, and what is excluded. For a deeper breakdown, see our guides to outsourced vs in-house medical billing and dental billing services cost.

What these numbers mean for your practice in 2026

1. Fix the front end first. Data, eligibility and registration errors drive most denials. Verify coverage before every visit.
2. Track your denial rate monthly. MGMA's 8% first-pass benchmark is a useful yardstick. If you are well above it, something is broken.
3. Appeal by default. Most denials are never appealed, yet a large share of appealed denials are overturned.
4. Budget for prior auth. At 39 requests per physician per week, it needs a dedicated owner and a process.
5. Compare total cost, not just the rate. A low percentage with exclusions can cost more than a higher all-in rate.

Frequently asked questions

What is the average claim denial rate in 2026?

It depends on the payer and the data set. MGMA reports an 8% single-specialty rate for claims denied on first submission, while 41% of providers in Experian Health's 2025 survey said their denial rates were 10% or higher. KFF found HealthCare.gov insurers denied 20% of in-network claims in 2023.

What causes most claim denials?

In Experian Health's 2025 survey, the top causes were missing or inaccurate data (50%), authorizations (35%) and incomplete or inaccurate patient registration (32%).

How much time do practices spend on prior authorization?

The AMA found practices complete 39 prior authorizations per physician per week, and physicians and staff spend about 13 hours a week on them.

How much does outsourced medical billing cost?

Outsourced billing is usually priced as a percentage of collections or a flat monthly fee. Rates vary by specialty, volume and services included.

How much does US healthcare spend each year?

According to CMS, US national health spending reached $5.3 trillion in 2024, or 18.0% of GDP. Physician and clinical services accounted for $1,109.7 billion.

Find out where your practice is losing revenue

Numbers like these are averages. Your practice has its own denial rate, A/R and payer mix. 24 Front Billing offers a free billing audit that shows where claims are getting stuck and what you could recover. No commitment, just a clear picture of your revenue cycle.