Medical Billing Denial Statistics 2026: Claims, Appeals, and Admin Work

Medical billing denial statistics can refer to a claim, a claim line, a service, a prior authorization request, or an entire encounter. Those units produce different rates. Any comparison should state the payer type, year, denominator, and whether the result includes corrected and resubmitted claims.

Marketplace claim evidence

KFF's analysis of federal Marketplace transparency data found that insurers denied 19% of in-network claims in 2023. The analysis also found that consumers appealed a very small share of denied claims. These results cover HealthCare.gov issuers that reported usable data. They are not a denial rate for Medicare, Medicaid, employer plans, or all medical practices.

CMS publishes Medicare Advantage organization determinations, reconsiderations, and appeals data. Those tables follow program definitions and should not be blended with commercial claim-line data. CMS also finalized interoperability and prior authorization requirements that set process and reporting expectations for affected payers.

What a practice should track

Report initial denials by payer, reason code, service, location, and submitting team. Keep first-pass acceptance separate from eventual payment. Measure days from denial to correction, appeal rate, appeal result, write-off value, and repeated root cause.

A medical virtual assistant can check claim status, maintain approved work queues, and collect documentation under a HIPAA-compliant process. Clinical decisions, coding judgments, and appeal representations need qualified oversight.

Sources

• KFF claims denial and appeals analysis
• CMS Marketplace transparency public use files
• CMS Medicare Advantage data
• CMS Interoperability and Prior Authorization Final Rule
• HHS HIPAA Security Rule guidance