100+ Revenue Cycle Management (RCM) Statistics for 2026

‍Last updated: November 2026

This page collects 116 revenue cycle management statistics for revenue cycle, managed care, payer contracting, and payer relations leaders, and for CFOs. The statistics cover claim denials, prior authorization, Medicare Advantage, payer reimbursement, patient estimates and collections, price transparency, automation, staffing, and hospital finances. Each figure names its source and the month the source published it.

Use these numbers to benchmark your organization and to show your leadership team where payer behavior costs you revenue.

Key takeaways

• Hospitals on Kodiak Solutions' platform lost $48.4 billion to final denials and unpaid patient balances in 2025, up 25% from 2024 (Fierce Healthcare, April 2026).
• HealthCare.gov insurers denied 19% of in-network claims in 2024, and enrollees appealed fewer than 1% of denied claims (KFF, March 2026).
• Medicare Advantage insurers overturned 80.7% of appealed prior authorization denials in 2024, but 88.5% of denials did not reach appeal (KFF, January 2026).
• Medicare paid hospitals 83 cents per dollar of cost in 2024, an underpayment of more than $100 billion (AHA, March 2026).
• Insured patient yield fell to 42.4% in 2025 as the patient share of hospital net revenue rose to 7.3% (Fierce Healthcare, April 2026).
• 2% of providers have fully or mostly integrated AI and automation across revenue cycle operations (HFMA and Guidehouse, April 2026).

Revenue cycle management market size statistics

1. Arizton valued the U.S. revenue cycle management market at $141.61 billion in 2024 and projects it will reach $272.78 billion by 2030, an 11.55% compound annual growth rate (Arizton, January 2025).
2. Precedence Research valued the U.S. RCM market at $65.43 billion in 2025 and projects it will reach $191.67 billion by 2035, an 11.35% compound annual growth rate (Precedence Research, June 2026).
3. U.S. health care spending grew 7.2% to $5.3 trillion in 2024, equal to 18.0% of GDP (CMS, January 2026).
4. Spending on hospital care grew 8.9% to $1.6 trillion in 2024 (CMS, January 2026).
5. 66% of providers outsource all or part of their revenue cycle to a managed services vendor (HFMA and Guidehouse, April 2026).

Hospital and medical group financial performance statistics

6. About 43% of hospitals operated at a loss in August 2026, compared with about 33% before the COVID-19 pandemic (Kaufman Hall, October 2026).
7. Hospitals' calendar year-to-date operating margin fell to 2.5% through August 2026, including allocations (Kaufman Hall, October 2026).
8. Total hospital expenses rose 21% over the three years through August 2026 (Becker's Hospital Review, reporting Kaufman Hall data, October 2026).
9. Total hospital expenses grew 7.5% in 2025, more than twice the growth rate of hospital prices (AHA, March 2026).
10. 84% of medical groups reported higher year-to-date operating costs in 2026 than in the same period of 2025, with an average increase of about 11% (MGMA, June 2026).
11. 36% of medical groups reported lower year-to-date revenue in 2026, up from 30% in 2025 (MGMA, July 2026).

Claim denial statistics for 2026

12. Insurers selling HealthCare.gov plans denied 19% of in-network claims in 2024 (KFF, March 2026).
13. The same insurers denied 37% of out-of-network claims in 2024 (KFF, March 2026).
14. In-network denial rates ranged from 3% to 36% across HealthCare.gov insurers in 2024 (KFF, March 2026).
15. Administrative reasons drove 25% of in-network denials on HealthCare.gov plans in 2024 (KFF, March 2026).
16. Marketplace enrollees appealed fewer than 1% of denied claims in 2024 (KFF, March 2026).
17. Insurers upheld 66% of the denials that marketplace enrollees appealed internally in 2024 (KFF, March 2026).
18. The median final denial rate for hospitals rose from 2.5% in 2024 to 2.7% in 2025 (Kodiak Solutions, March 2026).
19. Payers initially denied nearly 15% of claims in 2023, and denial rates reached 49% in some cases (Premier, February 2025).
20. 20% of providers in the 2026 HFMA and Guidehouse survey reported a denial rate above 5%, up from 12% a year earlier (HFMA and Guidehouse, April 2026).
21. 81% of provider leaders cite an increase in denials as a shift in payer behavior (HFMA and Guidehouse, April 2026).

Claim denial cost and lost revenue statistics

22. Hospitals on Kodiak Solutions' platform lost $48.4 billion in net revenue to final denials and uncollected patient balances in 2025, up 25% from $38.6 billion in 2024 (Fierce Healthcare, reporting Kodiak Solutions data, April 2026).
23. Hospitals spent $43 billion in 2025 trying to collect payments that insurers owed for care they had delivered (AHA, March 2026).
24. Hospitals spent nearly $18 billion in 2025 to overturn claim denials (AHA, March 2026).
25. Providers spent $25.7 billion on claims adjudication in 2023, up from $19.7 billion in 2022 (Premier, February 2025).
26. The average cost to adjudicate a denied claim rose from $43.84 in 2022 to $57.23 in 2023 (Premier, February 2025).
27. Payers overturned and paid 70% of the claims they initially denied in 2023 (Premier, February 2025).
28. Providers went through an average of three rounds of review with insurers to resolve a denial, and each round took 45 to 60 days (Premier, February 2025).
29. 88% of providers say disagreements over claims keep their organizations from getting paid on time and in full (HFMA and Guidehouse, April 2026).
30. 69% of provider leaders cite excessive information requests as a shift in payer behavior (HFMA and Guidehouse, April 2026).
31. The average time to insurance payment fell from 57.4 days in 2024 to 55.2 days in 2025 (Fierce Healthcare, reporting Kodiak Solutions data, April 2026).
32. Hospital and health system finance leaders estimate that 8.49% of their revenue is at risk from documentation or coding issues (Fierce Healthcare, reporting HFMA and AKASA survey data, December 2025).

Payer reimbursement and underpayment statistics

33. Medicare paid hospitals 83 cents for every dollar of cost in 2024, an underpayment of more than $100 billion (AHA, March 2026).
34. Hospitals' fee-for-service Medicare margin was negative 12.1% in fiscal year 2024 (MedPAC, March 2026).
35. MedPAC projects the hospital fee-for-service Medicare margin will improve to about negative 10% in 2026 (MedPAC, March 2026).
36. Service lines where reimbursement falls short of the cost of care account for 56.1% of hospital costs (AHA, March 2026).
37. Medicare physician payment fell 33% from 2001 to 2025 after adjusting for inflation (AMA, April 2025).
38. 73% of provider leaders report more unclear or vague denial reasons or underpayments from payers (HFMA and Guidehouse, April 2026).
39. 41% of provider leaders report reduced reimbursement rates from payers (HFMA and Guidehouse, April 2026).
40. A federal court gave final approval in August 2025 to a $2.8 billion Blue Cross Blue Shield settlement with providers, who alleged the plans divided geographic markets and lowered provider reimbursement (AHLA, August 2025).

Medicare Advantage statistics for providers

41. Medicare Advantage plans enrolled 35.2 million people in 2026, 55% of eligible Medicare beneficiaries (KFF, July 2026).
42. UnitedHealth Group and Humana together cover 46% of Medicare Advantage enrollees in 2026 (KFF, July 2026).
43. Medicare Advantage insurers made 52.8 million prior authorization determinations in 2024, up from 49.8 million in 2023 (KFF, January 2026).
44. Medicare Advantage insurers fully or partially denied 7.7% of prior authorization requests in 2024, up from 6.4% in 2023 (KFF, January 2026).
45. 11.5% of denied Medicare Advantage prior authorization requests went to appeal in 2024 (KFF, January 2026).
46. Medicare Advantage insurers overturned 80.7% of the prior authorization denials that reached appeal in 2024 (KFF, January 2026).
47. UnitedHealth Group denied 12.8% of Medicare Advantage prior authorization requests in 2024, the highest share among the major insurers KFF analyzed (KFF, January 2026).
48. Medicare Advantage plans required prior authorization on 30.5% of claims in 2023, up from 25% in 2022 (Premier, February 2025).
49. Medicare Advantage plans denied 17% of initial claim submissions in the Health Affairs analysis (Health Affairs, June 2025).
50. Medicare Advantage plans overturned 57% of those initial denials (Health Affairs, June 2025).
51. Denials that plans did not overturn cut provider revenue from Medicare Advantage claims by a net 7% (Health Affairs, June 2025).
52. Medicare Advantage plans had initial and final denial rates more than double those of traditional Medicare in 2025 (Kodiak Solutions, March 2026).

Prior authorization statistics for 2026

53. Physicians complete an average of 40 prior authorizations per week (AMA, May 2026).
54. Prior authorization consumes an average of 13 hours of physician and staff time each week (AMA, May 2026).
55. 40% of physicians employ staff who work exclusively on prior authorization (AMA, May 2026).
56. 95% of physicians say prior authorization delays access to necessary care (AMA, May 2026).
57. 79% of physicians report that patients abandon treatment because of authorization challenges (AMA, May 2026).
58. 26% of physicians report that prior authorization has led to a serious adverse event for a patient (AMA, May 2026).
59. 33% of physicians believe the latest insurer pledge to streamline prior authorization will make a meaningful difference (AMA, May 2026).
60. 44% of medical group leaders say payer prior authorization turnaround got slower in 2026, and 7% say it got faster (MGMA, September 2026).
61. 90% of medical practices report an increase in prior authorization burden over the past 12 months (MGMA, April 2026).
62. Payers required prior authorization on more than 20% of claims in 2023, up from 17% in 2022 (Premier, February 2025).
63. Payers had pre-approved 10.4% of the claims they denied in 2023 through prior authorization, up from 3.2% in 2022 (Premier, February 2025).
64. Missing prior authorization or referral caused 9% of in-network denials on HealthCare.gov plans in 2024 (KFF, March 2026).
65. 40% of medical prior authorizations were fully electronic in the 2025 CAQH Index, up from 35% in the 2024 Index (CAQH, now DataSpring, February 2026).
66. Starting in 2026, CMS requires Medicare Advantage, Medicaid, and CHIP payers to decide urgent prior authorization requests within 72 hours and standard requests within 7 calendar days (CMS, January 2024).

Patient financial responsibility and collections statistics

67. Workers with single employer coverage and a general annual deductible faced an average deductible of $1,886 in 2025 (KFF, October 2025).
68. The average deductible for single coverage rose 43% over the last 10 years (KFF, October 2025).
69. 34% of covered workers had a general annual deductible of $2,000 or more in 2025, up from 32% in 2024 (KFF, October 2025).
70. The average deductible for ACA Marketplace enrollees rose 37%, from $2,759 in 2025 to $3,786 in 2026 (KFF, May 2026).
71. ACA Marketplace plan sign-ups fell by more than 1 million, to 23.1 million, during open enrollment for 2026 (KFF, May 2026).
72. CBO estimates the 2025 reconciliation law will increase the number of uninsured people by 10 million in 2034 (KFF, August 2025).
73. Out-of-pocket health spending grew 5.9% to $556.6 billion in 2024 (CMS, January 2026).
74. The patient-responsibility share of hospital net revenue rose from 6.8% in 2024 to 7.3% in 2025 (Kodiak Solutions, March 2026).
75. Insured patient yield, the share of insured patients' balances that providers collect, fell from 45.1% in 2024 to 42.4% in 2025 (Fierce Healthcare, reporting Kodiak Solutions data, April 2026).
76. The median hospital bad debt rate rose from 1.1% in 2024 to 1.3% in 2025 (Kodiak Solutions, March 2026).
77. Hospital bad debt and charity care per calendar day rose 13% year over year in August 2026 (Becker's Hospital Review, reporting Kaufman Hall data, October 2026).

Patient estimate and upfront collection statistics

78. 17% of U.S. adults say they know what their health care will cost before they receive it (Gallup, January 2024).
79. 96% of likely voters agree that Americans deserve to know the price of their health care before they receive it (PatientRightsAdvocate.org and Echelon Insights, May 2025).
80. 75.2% of 1,150 urology clinics disclosed a self-pay price when secret shoppers called on behalf of an uninsured patient (JAMA Network Open, August 2026).
81. 28% of U.S. adults skipped or postponed needed health care in the past 12 months because of cost (KFF, September 2026).
82. 22% of U.S. adults had problems paying or were unable to pay medical bills in the past 12 months (KFF, September 2026).
83. Pre-service collections grew from an average of 16% of self-pay collections in 2025 to 21% in 2026 (HFMA and PayZen, May 2026).
84. 91.5% of provider organizations encourage payment, require it, or hold a payment method on file during the estimate process, up from 81.3% in 2025 (HFMA and PayZen, May 2026).
85. 17.1% of provider organizations formally require upfront payment, and 68% of those proceed with care when the patient does not pay (HFMA and PayZen, May 2026).
86. Point-of-service collections made up 24.8% of patient payments in the first quarter of 2026, up from 22.7% a year earlier (Kodiak Solutions, June 2026).
87. Single-specialty practices collected about 72% of copayments at the time of service in 2024, compared with 26.83% of patient-due balances (MGMA, August 2026).
88. Privately insured patients' average repayment rate on hospital out-of-pocket bills fell from about 54% before the COVID-19 pandemic to 46% for 2023 care (JAMA Health Forum, August 2025).
89. Repayment rates on privately insured patients' hospital bills over $1,000 were below 35% (JAMA Health Forum, August 2025).
90. 92% of commercially insured patients paid either all or none of their hospital bill (JAMA Health Forum, August 2025).

Price transparency and No Surprises Act statistics

91. 49.4% of the 2,000 hospitals PatientRightsAdvocate.org reviewed complied with the federal hospital price transparency rule, the highest rate it has recorded (PatientRightsAdvocate.org, September 2026).
92. 18% of the hospitals reviewed published dollar-and-cents prices for at least half of their items and services (PatientRightsAdvocate.org, September 2026).
93. CMS had fined 28 hospitals for price transparency violations, up from 15 at the time of PatientRightsAdvocate.org's previous report (PatientRightsAdvocate.org, September 2026).
94. Disputing parties initiated 1,372,563 federal IDR disputes from July through December 2025 (CMS, July 2026).
95. Providers or their representatives initiated 76% of those disputes (CMS, July 2026).
96. Providers, facilities, and air ambulance providers won about 85% of IDR payment determinations in the second half of 2025 (CMS, July 2026).
97. The winning offer exceeded the qualifying payment amount in about 87% of payment determinations in the second half of 2025 (CMS, July 2026).

Revenue cycle automation and AI adoption statistics

98. The U.S. health care industry avoided an estimated $258 billion in administrative costs in 2024 through electronic transactions (CAQH, now DataSpring, February 2026).
99. Full automation of the remaining manual and partially manual transactions represents a $21 billion savings opportunity (CAQH, now DataSpring, February 2026).
100. More than 50% of health plans and 25% of provider organizations use AI tools in administrative workflows (CAQH, now DataSpring, February 2026).
101. 80% of health systems are exploring, piloting, or implementing generative AI tools for the revenue cycle (Fierce Healthcare, reporting HFMA and AKASA survey data, December 2025).
102. 27% of healthcare finance leaders say their organizations deploy AI at scale across multiple functions, and 53% run pilots in select areas (HFMA, April 2026).
103. Nearly 60% of provider executives have not implemented any AI or automation in revenue cycle operations (HFMA and Guidehouse, April 2026).
104. 2% of providers have fully or mostly integrated AI and automation across revenue cycle operations (HFMA and Guidehouse, April 2026).
105. 20% to 40% of provider organizations report broad or enterprise-wide use of AI-enabled RCM tools (Oliver Wyman, April 2026).
106. Between 70% and 90% of provider decision-makers expect to increase spending on AI-enabled RCM capabilities over the next three years (Oliver Wyman, April 2026).
107. 34% of medical groups have used AI to build an app or workflow tool in-house (MGMA, September 2026).
108. 68% of medical groups have not redesigned a role or adjusted staffing with AI in the past year (MGMA, June 2026).
109. 6 in 10 physicians express concern that AI may further increase denial rates (AMA, May 2026).

Revenue cycle staffing and workforce statistics

110. The average hospital employed about 64 administrative and billing staff dedicated to billing and insurer payment functions in 2024, about 6.5% of total hospital employment (AHA, March 2026).
111. 40% of medical practices have three or more full-time administrative staff per physician (MGMA, April 2026).
112. Medical records specialists held about 200,700 jobs in 2025 (BLS, August 2026).
113. BLS projects employment of medical records specialists will grow 8% from 2025 to 2035, with about 14,000 openings each year (BLS, August 2026).
114. The median annual wage for medical records specialists was $51,140 in May 2025 (BLS, August 2026).
115. About 7% of healthcare finance leaders say their teams are "very prepared" for the revenue cycle of the future, and 44% say they are "somewhat prepared" (HFMA, April 2026).
116. The CPT 2026 code set includes 418 changes: 288 new codes, 84 deletions, and 46 revisions (AMA, September 2025).

What these numbers mean for your 2026 revenue cycle strategy

Payers reverse many of their own denials, and the reversal rate depends on the payer. Hospitals in Premier's survey got 70% of their initially denied claims paid in 2023. Medicare Advantage insurers reversed 80.7% of the prior authorization denials that went to appeal in 2024, but 88.5% of their denials never went to appeal. On HealthCare.gov plans, insurers upheld 66% of the denials that enrollees appealed. Working a denial costs an average of $57.23 per claim in Premier's analysis. Rank your open denials by dollar value and by how often each payer reverses that denial type, and work the list from the top.

Denial reports also miss underpayments. A claim that pays below your contracted rate posts as paid, so it never enters a denial work queue. In the 2026 HFMA and Guidehouse survey, 73% of provider leaders reported more unclear denial reasons or underpayments from payers, and 41% reported reduced reimbursement rates. If you manage payer contracts, compare paid amounts with contracted rates on every remittance, and bring each payer's underpayment totals to your next negotiation.

Patients owe a larger share of hospital revenue, and providers collect less of it. In Kodiak Solutions data, patient responsibility rose from 6.8% to 7.3% of hospital net revenue in 2025, while insured patient yield fell from 45.1% to 42.4%. Large balances are hard to collect after care: in the JAMA Health Forum study, repayment rates on privately insured patients' hospital bills over $1,000 were below 35%. Give patients an estimate before the visit and ask for payment at scheduling or check-in, starting with the services that leave patients owing the most.

At the 2.5% year-to-date operating margin hospitals reported through August 2026, a hospital with $500 million in operating revenue earns about $12.5 million in operating income. If that hospital recovered another $2.5 million, or 0.5% of revenue, from denials, underpayments, and patient balances, its operating income would rise 20%. Few providers have automated this recovery work: 2% have fully or mostly integrated AI and automation across the revenue cycle. Automate the checks your team repeats on every claim, such as comparing payments with contracted rates and sorting denials by payer and reason. Then review your denial rate, appeal overturn rate, and patient yield against the benchmarks on this page each quarter.

Methodology

MD Clarity compiled these statistics in October 2026 from sources published between January 2024 and October 2026. Sources include federal agencies (CMS and the Bureau of Labor Statistics), MedPAC, KFF, professional associations (the AHA, AMA, HFMA, and MGMA), peer-reviewed research in Health Affairs, JAMA Health Forum, and JAMA Network Open, and research, polling, and benchmarking firms (Gallup, Kodiak Solutions, Kaufman Hall, Premier, Oliver Wyman, Arizton, and Precedence Research). We checked each figure against its source. When a news outlet reported data from a report that is not public, we credit both the outlet and the original source. Survey results reflect each survey's sample, timing, and definitions. We excluded statistics that circulate on other pages without a traceable primary source.

Get paid fully and fairly with MD Clarity

MD Clarity is an AI-powered revenue optimization platform for healthcare providers. If you lead revenue cycle, RevFind's AI agent monitors your remit and contract data, flags underpayments and denial patterns, and answers plain-English questions about what payers owe you. If you run managed care or payer contracting, PayerMonitor gives your team AI-native contract management for every payer agreement. If you oversee patient access, Clarity Flow builds patient cost estimates and good faith estimates that support No Surprises Act compliance. If your team lacks the staff to work recoveries, MD Clarity's Revenue Recovery Services handle underpayment and denial recovery for you. Request a demo to find the revenue your payers owe you.