Denials and appeals are the biggest revenue cycle leak for medical groups. MGMA's January 6, 2026 Stat poll of 288 groups put them first at 48.0%, with front-end issues second at 23.0%.
Those two answers make up 71.0% of the responses. Billing and collections drew 14.0%, coding 13.0% and charge posting 2.0%.
Where do medical groups say revenue leaks?
MGMA published the results on January 7, 2026. Each respondent named the biggest revenue cycle leak in their group, and 288 responses were applicable.
| Biggest revenue cycle leak | Share of responses |
|---|---|
| Denials and appeals | 48.0% |
| Front-end issues | 23.0% |
| Billing and collections | 14.0% |
| Coding | 13.0% |
| Charge posting | 2.0% |
Source: MGMA Stat, "Detecting and fixing leaks across the revenue cycle," January 7, 2026. Poll date January 6, 2026, 288 applicable responses.
Physicians Practice reported the same results on January 20, 2026, and described front-end issues as eligibility and benefits verification. The remaining three stages share 29.0% of the responses. The poll measures opinion, not dollars lost, so a group with a small denial problem and a large coding problem would still land in its own category.
Each answer maps to a different owner. Front-end issues belong to schedulers and registration staff. Coding belongs to coders and clinicians. Charge posting belongs to billing staff, and at 2.0% it is the smallest leak in the poll.
MGMA also noted in the same post that 68.0% of groups added or expanded AI tools in 2025.
What is a normal first-submission denial rate?
MGMA's benchmark data put the first-submission denial rate at 7.0% to 8.0% over the past four years, according to its July 30, 2026 Stat post. MGMA cited the 2025 Financials and Operations report for a target below 5.0%.
The gap is easy to size. A practice that sends 10,000 claims a month has 800 first-pass denials at 8.0% and 500 at 5.0%. The difference is 300 claims a month that staff must read, correct and resubmit.
Veradigm surveyed 360 independent practice leaders in March 2026. It found that 48.0% say denials are rising. Veradigm is a health IT vendor that sells revenue cycle products, and the sample covers independent practices only.
What causes the denials practices see?
Veradigm asked the same 360 leaders which denial types they see. Seven of nine types landed between 25.0% and 39.0%, so no single cause dominates. Its August 21, 2026 post lists six of them.
| Denial driver | Share of practices citing it |
|---|---|
| Eligibility and coverage issues | 39.0% |
| Coding errors | 38.0% |
| Missing or incomplete claim information | 34.0% |
| Prior authorization issues | 34.0% |
| Payer policy changes | 34.0% |
| Documentation gaps | 33.0% |
Source: Veradigm, "Revenue Leakage in Healthcare: What 360 Leaders See," August 21, 2026. Survey of 360 independent practice leaders, March 2026.
Eligibility and coverage is the largest driver at 39.0%, and it sits at the front end of the cycle. Only 24.0% of the leaders said they have clear visibility into where their revenue leaks. Another 54.0% reported more financial pressure over the past 12 months.
Staffing adds to the load. Veradigm found that billing staff are the second hardest role to recruit, at 44.0%, behind physicians. Among practices with more than 40 clinicians, 82.0% reported more financial pressure, against 54.0% across the full sample.
How much prior authorization work feeds the leak?
The AMA's 2025 prior authorization survey of 1,000 practicing physicians came out in May 2026. Medical Economics reported on October 12, 2026 that physicians handle 40 prior authorization requests each week.
The same survey found that nearly a third of those requests are often or always denied outright. It also found that 95.0% of physicians say prior authorization delays care patients need.
Veradigm's list puts prior authorization issues at 34.0% of the denial drivers practices cite. At 40 requests a week, a physician sends about 2,080 requests a year, a figure that comes from multiplying the AMA's weekly count by 52 weeks.
How do days in A/R and patient collections compare?
MGMA polled 203 groups on July 28, 2026 and asked how days in A/R compare with a year ago. The largest group, 43.0%, said about the same.
| Days in A/R versus a year ago | Share of groups |
|---|---|
| About the same | 43.0% |
| Higher | 32.0% |
| Lower | 22.0% |
| Unsure | 3.0% |
Source: MGMA Stat, "Days in A/R holds steady for most practices but payer pressure persists in 2026," July 30, 2026. Poll date July 28, 2026, 203 applicable responses.
MGMA cited one revenue cycle overhaul that cut days in A/R from 67 to under 34. On the patient side, MGMA's 2024 data show practices collected 72.0% of copayments at the time of service and about 27.0% of other patient-due balances. In an October 21, 2025 MGMA poll, 66.0% of groups said they held or improved patient balance collections.
The same July post lists timing targets for the front of the cycle. Clinicians close encounters within 72 hours, and staff post charges within two days. MGMA also advises practices to make it easy to pay in the first seven days, with text-to-pay, portal links that work, clearer itemization and fewer handoffs.
What does the leak cost in dollars?
Kodiak Solutions' report on 2025 data covers more than 2,300 hospitals and 375,000 physicians. It found that net revenue leakage grew 25.0%, and that hospitals lost more than $48 billion to final denials and bad debt. Medical Economics reported these figures on October 12, 2026.
MGMA's DataDive figures for hospital-owned groups show bad debt of $43,073 per full-time-equivalent physician in nonsurgical specialties and $48,337 in surgical specialties. On that base, a hospital-owned group with 10 nonsurgical physician FTEs carries $430,730 in bad debt.
Sources
- MGMA, Detecting and fixing leaks across the revenue cycle, January 7, 2026
- Physicians Practice, MGMA poll: Denials are biggest revenue-cycle leak for medical practices, January 20, 2026
- MGMA, Days in A/R holds steady for most practices but payer pressure persists in 2026, July 30, 2026
- Veradigm, Revenue Leakage in Healthcare: What 360 Leaders See, August 21, 2026
- Veradigm, Independent and Under Pressure: What 360 Practice Leaders Told Us in 2026
- Medical Economics, Why claim denials are rising and why most practices are fixing the wrong problem, October 12, 2026
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