Reference
Medical billing and RCM benchmarks
What a normal denial rate actually is, what a denial actually costs, and where practices actually sit on days in AR — with every figure traceable to a named publisher, dataset and year.
Last reviewed August 20, 2026
Denials
8%
first-submission denial rate, physician practices
11.8%
initial denial rate, hospitals and health systems
41%
of providers report denial rates above 10%
84%
of claim denials are potentially avoidable
44%
of denials originate at the front end
24.3%
of denials are registration and eligibility errors
Why claims are denied
The three largest categories are all front-end
Registration and eligibility
24.33%
Missing or invalid claim data
15.89%
Authorization and precertification
12.80%
Medical documentation requested
12.08%
Service not covered
9.67%
Medical necessity
6.76%
Cost and recovery
$57.23
average cost to fight a single denied claim
~70%
of denied claims are overturned and paid on appeal
$18B
spent annually adjudicating claims that should have paid
Accounts receivable and administration
47
median days in accounts receivable
~70 min
of administrative work per patient visit
25 min
per claim status inquiry made by phone
$11.7B
annual savings available from electronic eligibility verification
~$73,000
fully loaded annual cost of one in-house biller
68%
say submitting clean claims is harder than a year ago
Prior authorization
13 hrs
per physician per week on prior authorization
80.7%
of appealed Medicare Advantage prior-auth denials are overturned
What we deliberately excluded
Statistics we won't repeat
Several figures saturate medical billing marketing despite having no verifiable primary source, or being a decade old and still quoted as current. We checked, and left them out. Here they are, so you can recognize them elsewhere.
| Claim | Why we excluded it |
|---|---|
| “50–65% of denied claims are never reworked” | No primary study, sample or methodology exists. Appears even in HFMA content without a citation. |
| “90% of denials are preventable” | Traces to an Advisory Board blog post from December 2014. |
| “$118 to rework a denied claim” | Change Healthcare, 2016 data. Superseded by Premier's $57.23 (2023). |
| “$181 to rework a denied claim” | No traceable source of any kind. |
| “95% clean claim rate is the HFMA benchmark” | HFMA publishes MAP Key definitions only — no public benchmark values. |
| “80% of medical bills contain errors” | An advocacy group's self-selected caseload, not a study. |
| “Patient responsibility is 30%+ of provider revenue” | Contradicted by Kodiak Solutions: 7.3% of net patient revenue. |
This matters beyond pedantry. If a vendor quotes you a statistic that dissolves on inspection, it is reasonable to wonder what else they have not checked.
See how your practice compares
A free billing audit measures your denial rate, AR aging and clean claim rate against these benchmarks — using your actual numbers rather than industry averages.
No setup fees · You pay when we collect · Pricing from 3% of net collections