Industry Data
The State of Claim Denials — the numbers every practice owner should know.
We maintain this page as a public resource, updated as major industry reports publish. Every figure is attributed. Cite it, share it, bring it to your next board meeting.
Denial Rates
More than one in ten claims now comes back denied.
41%
41% of healthcare providers report denial rates of 10% or higher — a figure that has risen every year since 2022 — Experian Health, State of Claims 2025
11.8%
Initial claim denial rates hit 11.8% in 2024, up from ~10.2% a few years earlier — Industry claims data, 2024
+4.8%
Medicare Advantage denials jumped 4.8% from 2023 to 2024; commercial plan denials rose 1.5% — Industry claims data, 2024
What this means for your practice: denial rates are not a fixed cost of doing business — they are rising, and Medicare Advantage is rising fastest. A denial rate that was tolerable three years ago is quietly costing you more every year, even if nothing about your billing changed.
The Cost of Fighting Back
Fighting denials is expensive. That's the payers' moat.
$25–$100+
The average cost to rework a single denied claim is $25 — and can run over $100 per appeal; some estimates range up to $118–$181 — MGMA / HFMA / Change Healthcare industry reports
$19.7B
Hospitals and health systems spent an estimated $19.7 billion in a single year fighting denied claims — American Hospital Association / Premier data (2022)
13 hrs/wk
Physicians and staff spend an average of 13 hours per week on prior authorization tasks — AMA 2024 Prior Authorization Report
What this means for your practice: every denial forces a choice between eating the loss and paying staff to fight it. Hospital systems spend billions on that fight; an independent practice spends Brenda's Friday afternoon. The economics of fighting back are exactly why most practices don't — and why a results-priced specialist unit changes the math.
The Recovery Gap
Most denials are winnable. Almost none are fought.
50–65%
50–65% of denied claims are NEVER reworked or resubmitted — MGMA
~2/3
Roughly two-thirds of denied claims are recoverable — Advisory Board
54–57%
Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned — Federal MA appeals data / KFF
<1%
Fewer than 1% of patients ever appeal a denial — KFF analysis
What this means for your practice: the gap between how often appeals win (over half, for Medicare Advantage) and how often anyone files one (almost never) is the single largest pool of recoverable money in your AR. Denials don't stand because they're right. They stand because they're unopposed.
Want these numbers for YOUR practice instead of the industry? That’s the Recovery Audit — a $500 analysis, currently free.
Get Your Free Recovery Audit →What It Means Financially
The leak shows up in net revenue, not on any report.
~$1,000
The average denied Medicare Advantage claim is now worth about $1,000 — up 22.4% year over year — MDaudit network data, 2025
1–3%
Commercial payer underpayments quietly cost providers 1–3% of net revenue annually — Industry revenue-integrity analyses
5–10%
Providers who don't actively manage denials often have 5–10% of gross revenue tied up in denied or underpaid claims at any time — HFMA-aligned industry analysis
What this means for your practice: between denials, underpayments, and aged AR, a practice that isn't actively managing this can have a mid-single-digit percentage of its gross revenue sitting in payer limbo at any moment — money already earned, care already delivered, no line item anywhere calling it what it is.
The Trend
It's getting worse — and it's mostly preventable.
60%
60% of medical groups reported higher denial rates in 2024 vs. 2023 — MGMA 2024 Stat Poll
82%
82% of healthcare CFOs say payer denials have increased significantly since pre-pandemic — HFMA, 2024
86–90%
As many as 86–90% of denials are preventable — Kaiser Family Foundation research
What this means for your practice: CFOs across the industry agree denials are climbing, yet the research says the overwhelming majority are preventable. The practices that win the next five years will be the ones that both recover what's owed and fix the upstream causes — which is why prevention reporting is a deliverable in every Claimie engagement.
Full Sources
- S1.41% of healthcare providers report denial rates of 10% or higher — a figure that has risen every year since 2022. — Experian Health, State of Claims 2025
- S2.Initial claim denial rates hit 11.8% in 2024, up from ~10.2% a few years earlier. — Industry claims data, 2024
- S3.Medicare Advantage denials jumped 4.8% from 2023 to 2024; commercial plan denials rose 1.5%. — Industry claims data, 2024
- S4.The average cost to rework a single denied claim is $25 — and can run over $100 per appeal; some estimates range up to $118–$181. — MGMA / HFMA / Change Healthcare industry reports
- S5.50–65% of denied claims are NEVER reworked or resubmitted. — MGMA
- S6.Roughly two-thirds of denied claims are recoverable. — Advisory Board
- S7.As many as 86–90% of denials are preventable. — Kaiser Family Foundation research
- S8.Hospitals and health systems spent an estimated $19.7 billion in a single year fighting denied claims. — American Hospital Association / Premier data (2022)
- S9.60% of medical groups reported higher denial rates in 2024 vs. 2023. — MGMA 2024 Stat Poll
- S10.82% of healthcare CFOs say payer denials have increased significantly since pre-pandemic. — HFMA, 2024
- S11.The average denied Medicare Advantage claim is now worth about $1,000 — up 22.4% year over year. — MDaudit network data, 2025
- S12.Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned. — Federal MA appeals data / KFF
- S13.Fewer than 1% of patients ever appeal a denial. — KFF analysis
- S14.Commercial payer underpayments quietly cost providers 1–3% of net revenue annually. — Industry revenue-integrity analyses
- S15.Physicians and staff spend an average of 13 hours per week on prior authorization tasks. — AMA 2024 Prior Authorization Report
- S16.Providers who don't actively manage denials often have 5–10% of gross revenue tied up in denied or underpaid claims at any time. — HFMA-aligned industry analysis
Last reviewed against published industry reports. Figures are industry aggregates, not Claimie client results.
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The one-page worksheet to total up what your denials actually cost — the same math we run in the Recovery Audit.
Know your number before you sign anything.
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