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Medical billing statistics, 2026.

What billing companies charge, what a biller is measured on, what in-house billing costs, and what the law says about percentage fees. The fee ranges are the billing companies’ own and are labelled that way. The rest comes from Premier’s denial survey, MGMA’s polls and benchmarks, the CAQH Index and federal wage data, plus one engagement of ours.

Jeff Weinberg, JRW · Checked 21 August 2026

What billing companies charge.

No independent survey of fees exists. These are the companies’ own ranges.

  1. 4% to 10% (link to this figure)

    Outsourced billing is quoted at 4% to 10% of collections. Most small-practice quotes fall between 5% and 8%.

    Vendor figure: GetPracticeHelp and other vendor guides, 2026. Vendor price guides, 2026

    Specialists are often quoted lower, 3% to 8%, because they bill fewer, larger claims. Some contracts charge on gross charges rather than net collections. Setup, clearinghouse, statement, resubmission and minimum fees come on top.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-fee-4-10, checked 21 August 2026

  2. $4 to $10 (link to this figure)

    Per-claim pricing, where offered. Flat plans run $200 to $1,000 per provider per month.

    Vendor figure: GetPracticeHelp and other vendor guides, 2026. Vendor price guides, 2026

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-fee-per-claim, checked 21 August 2026

  3. $100 to $500 (link to this figure)

    Per provider per month for cloud billing or practice management software. Clearinghouse fees add $0.25 to $1.00 a claim.

    Vendor figure: Vendor pricing pages and roundups, 2026. Vendor pricing pages, 2026

    Paid whether billing is in-house or out, in most contracts.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-software-100-500, checked 21 August 2026

  4. $5.5B to $7.4B (link to this figure)

    Estimates of the US medical billing outsourcing market in 2025, depending on the research firm.

    Vendor figure: Market research firms, 2025. Paid market reports

    All project 12% to 13% annual growth. Definitions differ.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-market-5-7, checked 21 August 2026

  5. 36% (link to this figure)

    Of practice leaders said they would outsource or automate part of revenue cycle management in 2025. Half said no.

    Survey: MGMA Stat, 2024. 352 practice leaders, November 2024

    This measures intent. We found no published count of practices that already outsource billing.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-outsource-36, checked 21 August 2026

  6. 13.7% (link to this figure)

    The cost of in-house billing as a share of collections, as vendors cite it and attribute it to MGMA. We could not find it in any MGMA publication, and the guides that repeat it name no report.

    Vendor figure: GetPracticeHelp and other vendor guides, 2026. No sample; no primary source located

    Treat it as unsourced. The calculator builds the in-house cost from claim volume and wages instead.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-137, checked 21 August 2026

What a biller is measured on.

  1. 15% (link to this figure)

    Nearly 15% of claims to private payers were denied on first submission.

    Survey: Premier Inc., 2024. 516 hospitals in 36 states, 2022 claims, published March 2024

    Hospitals, not physician practices. MGMA’s practice figure is lower, below.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-denied-15, checked 21 August 2026

  2. 54.3% (link to this figure)

    Of those denied claims were eventually paid, after one or more appeals.

    Survey: Premier Inc., 2024. 516 hospitals

    More than half of denied claims were paid in the end, and each one took an appeal that someone on the billing side wrote.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-denied-paid-54, checked 21 August 2026

  3. $43.84 (link to this figure)

    Administrative cost per claim to fight a denial, clinical labor excluded. About $19.7 billion a year across the industry.

    Survey: Premier Inc., 2024. 516 hospitals

    Change Healthcare’s 2017 estimate was $118 per claim, also hospitals.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-rework-4384, checked 21 August 2026

  4. 7% to 8% (link to this figure)

    First-submission denial rate at medical practices over the past four years, per MGMA benchmarking. Below 5% is achievable with targeted fixes.

    Survey: MGMA Stat, 2026. MGMA DataDive, cited July 2026

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-denials-7-8, checked 21 August 2026

  5. 60% (link to this figure)

    Of practice leaders said denials were up on the year before. 11% said down.

    Survey: MGMA Stat, 2024. 235 practice leaders, March 2024

    The 2023 DataDive put the single-specialty first-submission rate at 8%, unchanged from 2019.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-denials-up-60, checked 21 August 2026

  6. 48% (link to this figure)

    Of medical group leaders named denials and appeals as their largest source of revenue leakage. 23% named front-end errors.

    Survey: MGMA Stat, 2026. MGMA Stat poll, January 2026

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-leakage-48, checked 21 August 2026

  7. 95% (link to this figure)

    Minimum net collection rate: payments divided by charges net of contractual adjustments. Optimal is 97% to 99%.

    Survey: MGMA with Conifer Health Solutions, 2023. MGMA and Conifer benchmark paper, April 2023, citing the AAFP

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-net-collection-95, checked 21 August 2026

  8. 30 to 40 (link to this figure)

    Optimal days in accounts receivable. Under 10% of A/R more than 90 days old. Clean claims rate 98%.

    Survey: MGMA with Conifer Health Solutions, 2023. Benchmark paper, April 2023

    Targets assembled from several published sources rather than one survey.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-days-ar-30-40, checked 21 August 2026

  9. 43 / 32 / 22 (link to this figure)

    Percent of medical groups whose days in A/R were the same, higher and lower than a year earlier.

    Survey: MGMA Stat, 2026. 203 medical group leaders, July 2026

    Those with higher A/R blamed payer behavior most: slower payment, denials, downcoding, records requests.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-ar-trend-43, checked 21 August 2026

  10. 9% (link to this figure)

    Of hospital charges were denied on first submission in 2016, $262 billion. 63% were recoverable.

    Measured, vendor data: Change Healthcare, 2017. 724 hospitals on one vendor’s platform, extrapolated

    Registration and eligibility errors were the leading cause, 23.9%.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-change-9, checked 21 August 2026

What in-house billing costs.

  1. $48,500 (link to this figure)

    Median annual pay of billing and posting clerks, all industries. About $23.32 an hour before benefits and overhead.

    Official: US Bureau of Labor Statistics, Occupational Outlook Handbook, 2025. Federal wage data, May 2025

    418,000 jobs, projected flat to 2035.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-wage-48500, checked 21 August 2026

  2. $63,874 (link to this figure)

    Average salary of a Certified Professional Biller in the AAPC’s 2025 survey, as reported second-hand.

    Vendor figure: AAPC, reported second-hand, 2025. AAPC members; we could not open the report

    Credentialed members only, so well above the federal median.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-cpb-63874, checked 21 August 2026

  3. 6,700 (link to this figure)

    Claims one biller processes a year, the only published median, from 2008.

    Vendor figure: Physicians Practice, 2008. No sample named

    The practice in our case ran 11,700 per biller with two billers and was behind on denials.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-claims-6700, checked 21 August 2026

  4. 0.61 (link to this figure)

    Staff per full-time provider in patient accounting, general accounting and managed-care administration, costing multispecialty practices 2.7% of net medical revenue.

    Vendor figure: Physicians Practice, 2008. MGMA data as cited in 2008

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-staff-061, checked 21 August 2026

  5. $6.33 / $3.05 (link to this figure)

    Provider cost to submit a claim manually versus electronically. 12 minutes versus 5.

    Survey: CAQH, 2024. Plans and providers, 2023 data

    Labor only. System costs and follow-up excluded.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-caqh-submit, checked 21 August 2026

  6. 25 min (link to this figure)

    A claim status inquiry by phone, the longest manual task CAQH measured. $13.80, against $3.64 and 7 minutes electronically.

    Survey: CAQH, 2024. 2024 CAQH Index

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-caqh-status, checked 21 August 2026

  7. $5.67 / $2.95 (link to this figure)

    Provider cost to process a remittance manually versus electronically. Eligibility checks: $8.57 and 16 minutes manual, 4 minutes electronic.

    Survey: CAQH, 2024. 2024 CAQH Index

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-caqh-remit, checked 21 August 2026

Percentage fees and the law.

Not legal advice. The rules differ by state and by payer.

  1. 424.73 (link to this figure)

    Medicare may pay a billing agent on the provider’s behalf only if the agent’s compensation is not related in any way to the amounts billed or collected and does not depend on collection.

    Official: Code of Federal Regulations, via Cornell LII, 2026. Code of Federal Regulations, Title 42

    It governs payment made to the agent, which is why percentage billers must have payments go to the practice.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-cfr-42473, checked 21 August 2026

  2. 4.5% (link to this figure)

    The fee in a billing contract the Illinois Appellate Court voided in 2008 under the state’s fee-splitting ban. Illinois has since changed the law: a percentage fee for billing and collection is allowed if the practice controls what is charged and collected and the money goes straight to the practice.

    Legal analysis: Foley & Lardner, 2008. Center for Athletic Medicine v. Independent Medical Billers of Illinois

    The court suggested a flat fee tied to volume and complexity would be valid.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-il-45, checked 21 August 2026

  3. 9% (link to this figure)

    Interest New York’s Medicaid Fraud Control Unit added to the recoupment it sought from providers whose billing companies were paid a percentage of Medicaid collections.

    Legal analysis: Mintz, 2017. MSSNY warning to members, February 2017

    Under 18 NYCRR 360-7.5(c), a Medicaid billing agent’s pay must be unrelated to the amounts billed and collected. The medical society told members to pay billers by time or a flat fee.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-ny-9, checked 21 August 2026

  4. 2 (link to this figure)

    States that make a percentage fee-splitting arrangement a misdemeanor: Virginia and Tennessee. Each state has its own rule; New York is the strictest and California allows most percentage agreements at fair market value.

    Legal analysis: Liles Parker, 2022. Health-law firm review, 2022

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-states-30, checked 21 August 2026

Underpayments.

The figures that circulate are second-hand, and each is labelled that way.

  1. 7% to 11% (link to this figure)

    Of net revenue lost to underpaid and unpaid claims, as vendors cite it and attribute it to MGMA. We could not locate the study.

    Vendor figure: Vendor blogs citing MGMA and Change Healthcare, 2025. Vendor blogs; no primary source located

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-under-7-11, checked 21 August 2026

  2. 69% (link to this figure)

    Of healthcare organizations reported underpayments from commercial insurers in 2019, per MGMA as cited by vendors.

    Vendor figure: Vendor blogs citing MGMA and Change Healthcare, 2025. Second-hand

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-under-69, checked 21 August 2026

  3. 5% to 15% (link to this figure)

    Of claims underpaid, a Change Healthcare figure cited by vendors.

    Vendor figure: Vendor blogs citing MGMA and Change Healthcare, 2025. Second-hand

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#bill-under-5-15, checked 21 August 2026

From our work.

One measured engagement and one calculator output.

  1. 84% to 96% (link to this figure)

    First-pass claim acceptance at a five-provider internal medicine practice, before and after an agent began checking every claim against the payer’s rules. Days in A/R fell from 46 to 31.

    JRW engagement: JRW case study, 2026. One engagement, 2026, about 450 claims a week

    The case study.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#jrw-accept-84-96, checked 21 August 2026

  2. $68k (link to this figure)

    Underpayments found in the first year at the same practice by checking each remittance against the contract. 35 hours a week of billing staff time back.

    JRW engagement: JRW case study, 2026. One engagement, 2026

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#jrw-under-68k, checked 21 August 2026

  3. $184,800 (link to this figure)

    What a five-provider primary care practice pays a billing company a year at the calculator defaults: 6% of $3 million in collections plus $400 a month in extras.

    Our default: JRW, 2026

    Medical billing cost calculator: the same claims in-house with an agent, and the denials and underpayments recovered, before our fee.

    Cite

    JRW, “Medical billing statistics 2026”, https://jrw-tech.com/blog/medical-billing-statistics#jrw-billing-cost, checked 21 August 2026

The labels.

  • Measured. Call logs, records or a trial, with a stated sample, from someone not selling a fix for the problem measured.
  • Measured, vendor data. A vendor’s own platform data, with a stated sample.
  • Survey. A survey or secret-shopper study, with a stated sample.
  • Official. Government statistics, statutes and regulations.
  • Legal analysis. A law firm’s or court’s account of a law or ruling. Not legal advice for your state.
  • Vendor figure. Published or repeated by a company that sells a related product, with no independent check. Some have no primary source we could find; the note says which. Where a calculator starts from one, its defaults table says so.
  • JRW engagement. Measured in one of our own client engagements. We sell the work being measured, so read it as one practice’s result, not a benchmark.
  • Our default. A number we chose, or a JRW calculator’s output at its default settings. The calculator page shows the assumptions.

To cite a figure, copy its cite line. Anchors are stable. Corrections: jeff@jrw-tech.com.

Questions.

Where do the fee ranges come from?
From billing companies’ own price guides. We found no independent survey of fees by an association or researcher. The ranges agree with each other, which is some comfort, and they are labelled as vendor figures on this page.
Is 15% the denial rate for a physician practice?
No. Premier’s 15% is hospitals. MGMA’s benchmarking puts practices at 7% to 8% on first submission, and says under 5% is achievable. Your own rate is on your clearinghouse report.
Is a percentage-of-collections billing contract illegal?
It depends on the state and the payer. Medicare restricts it when the agent receives the payment. An Illinois court voided one in 2008, and Illinois has since allowed them if the practice controls the fees and receives the money. New York has pursued recoupment from Medicaid providers who had them. Each state has its own rule. Ask a healthcare lawyer in your state.
Can I cite these?
Cite Premier, MGMA, CAQH or the BLS for their figures. Cite JRW for the case measurements, the calculator output and this page.

Compare your billing fee with billing in-house.

The calculator starts from these figures and takes your practice’s numbers.

Open the medical billing calculator

Related: What a medical billing company costs · How to replace your billing company · Claim denial statistics · Claims and payments case study · Claims and payments automation