In Guidehouse and HFMA's 2026 survey of 191 provider executives, 39% of medical group leaders reported a final denial rate above 5%. The share was 25% among hospital leaders and 19.7% across all respondents, up from 12% in the prior survey.
Guidehouse and the Healthcare Financial Management Association (HFMA) surveyed the executives in late 2025. CFOs made up 47% of respondents, and vice presidents of finance, operations, or revenue cycle made up 40%. By organization type, 52% were hospitals, 39% were health systems, and 9% were medical groups. Medical groups were the smallest group, at about 17 executives.
How final denial rates are spread across providers
The report sorts respondents into six bands of final denial rate. The first three bands, through 3%, hold 57.0% of respondents. The other 43.0% report a rate above 3%. The two top bands together, above 4%, hold 31.7%.
| Final denial rate | Share of 191 respondents |
|---|---|
| 0% to 1% | 6.3% |
| 1.1% to 2% | 28.2% |
| 2.1% to 3% | 22.5% |
| 3.1% to 4% | 11.3% |
| 4.1% to 5% | 12.0% |
| Above 5% | 19.7% |
Source: Guidehouse and HFMA, 2026 Revenue Cycle Management Trends, survey of 191 provider executives, late 2025.
The largest band is 1.1% to 2%, at 28.2%. The top band holds 19.7%, more than the 12.0% in the 4.1% to 5% band or the 11.3% in the 3.1% to 4% band. That top band is open ended, so it covers every rate above 5%. The report says the share above 5% nearly doubled from the prior survey.
Kodiak Solutions gives a second reference point from claims data. In a March 31, 2026 release on 2025 results, Kodiak reported a median final denial rate of 2.7%, up from 2.5% in 2024. Its data covers more than 2,300 hospitals and 375,000 physicians. Kodiak said clinical denials, which cover missing prior authorization and medical necessity, drove virtually all of the increase.
In the Guidehouse and HFMA bands, the running total reaches 34.5% at 2% and 57.0% at 3%. The survey median therefore falls in the 2.1% to 3% band, the same band as the Kodiak median. One source is claims data and the other is what executives reported, so treat the match as a rough check.
Medical groups report higher rates than hospitals and health systems
This is the first year the survey split denial results by organization type. Nearly 7 in 10 medical group leaders said their denial rate exceeds 3%. Just over half of hospital leaders said the same. More than half of health system leaders reported a rate of 2% or lower.
At the higher threshold, 39% of medical group executives and 25% of hospital executives reported rates above 5%. Across all respondents, 34.5% report a rate of 2% or lower.
The medical group base is small. Nine percent of 191 respondents is about 17 people, and 39% of 17 is about 7 people. Use the medical group figures as one data point to compare with your own final denial rate. The survey gives no national rate for practices. A practice can place its own final denial rate in one of the six bands and compare the medical group figures with that band.
Half of medical group executives said they met inconsistent coverage policies from payers. The report says payer behavior was otherwise consistent across organization types, and medical group executives were more likely than others to report this issue.
What providers say changed at the payer
Most respondents named several payer changes over the past 12 months. The report charts the share that named each one. It titles the chart "Payer Behavior Observed by Health Systems" and gives no base beyond that.
| Payer change reported, past 12 months | Share |
|---|---|
| Increase in denials | 81% |
| Increase in prior authorization delays | 74% |
| Increase in unclear or vague denial reasons or underpayments | 73% |
| Excessive information requests | 69% |
| Reduced reimbursement rates | 41% |
Source: Guidehouse and HFMA, 2026 Revenue Cycle Management Trends, survey of 191 provider executives, late 2025.
Payer challenges ranked among the top three concerns for 88% of all executives, up from 86% a year earlier. Front-end approvals and prior authorization came next at 42%. Regulatory and legislative compliance drew 34%, workforce 33%, and technology adoption and integration 29%.
Cost to collect moved the other way. In the prior survey, 25% ranked it a top concern. This year 12% did.
Where providers put money against denials
Revenue cycle technology stayed the top investment priority for the next 12 months, with 69% of respondents rating it among their highest. Payer relations and managed care followed at 49%, and clinical documentation improvement and revenue integrity at 47%. EHR integration or optimization reached 35%. Front-desk work draws money too: 40% invest in scheduling, registration, and access, and 21% in patient financial services.
Guidehouse says consistent staff training and standardized coding help organizations catch errors early, and that improved documentation does the same.
Among respondents, 39.2% have a vendor manage denials and appeals, and 17.6% outsource eligibility and prior authorization. Accounts receivable follow-up and collections leads that list at 66.7%.
Automation is at an early stage. In the report's maturity question, 42.4% are exploring use cases with no tool in place. Another 39.4% run point solutions for tasks such as denials, coding, or prior authorization. A further 16.4% have not explored AI or automation. Only 1.8% report that AI or automation is fully or mostly integrated across their revenue cycle.
Health systems were more likely than other respondents to have implemented AI or automation. Most hospital and medical group executives said they have not.
Sources
- Guidehouse and HFMA, 2026 Revenue Cycle Management Trends, 2026
- Kodiak Solutions, Healthcare Provider Organizations Saw Net Revenue Losses From Final Denials and Bad Debt Grow by 25% in 2025, March 31, 2026
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