MGMA poll: Denials are biggest revenue-cycle “leak” for medical practices

Denials and appeals are the leading source of revenue “leakage” for medical practices, according to a new Medical Group Management Association (MGMA) Stat poll that also points to persistent breakdowns at the front desk, in coding and documentation, and in patient collections.

In the Jan. 6 poll, 48% of respondents said denials and appeals were the biggest leak in their revenue cycle, MGMA reported in a post published Jan. 7. Another 23% cited front-end issues such as eligibility and benefits verification, followed by billing and collections (14%), coding (13%) and charge posting (2%). MGMA said the poll drew 288 applicable responses.

MGMA’s takeaway: Many organizations don’t have one failure point, they have a chain reaction. An eligibility miss at scheduling or check-in can turn into a denial, a delayed bill and an aging account, the association said.

Denials: Payer rules, prior authorization and medical necessity disputes

Respondents described denials as “overwhelmingly payer-driven and preventable,” MGMA said, citing common themes such as medical necessity determinations, noncovered services, bundling and global package edits, utilization-management friction tied to prior authorization and post-service records requests, eligibility and coordination-of-benefits problems, timely filing, and credentialing- or CLIA-related denials.

The survey findings arrive as practices continue to report heavy administrative burden tied to prior authorization. The American Medical Association has reported that prior authorization consumes staff time and contributes to physician burnout. Federal watchdogs have also flagged concerns in Medicare Advantage, with the HHS Office of Inspector General reporting that some denied prior authorization requests met Medicare coverage rules.

A fix that starts before the claim: Front-end discipline

Physicians Practice coverage has long argued that denial prevention is often an upstream problem, not a back-end heroics problem: verify eligibility, confirm deductibles, and check prior authorizations before the visit when possible.

One practical starting point is measurement. A Physicians Practice article on revenue KPIs recommends verifying eligibility for every single patient for every appointment, confirming how much deductible has been met, and tracking denial percentage, bill lag and days in accounts receivable to identify process drift.

Patient-pay pressure shows up in collections

Billing and collections ranked third in MGMA’s poll, with respondents pointing to higher patient responsibility and inconsistent point-of-service collection.

On the practice side, Physicians Practice has urged leaders to set expectations early and make it easier to pay. Recent guidance includes collecting balances at check-in with clear signage and staff scripting, plus tracking point-of-service collections for consistency.

Coding: Undercoding and documentation gaps can quietly drain revenue

Coding was identified as the biggest leak by 13% of MGMA poll respondents, with MGMA pointing to undercoding — particularly for evaluation and management services — missed codes, modifier issues and documentation gaps that fail to support medical necessity.

Physicians Practice recently published a 2026-focused coding guide that argues “simple, repeatable coding habits” can cut denials, support compliance and protect margins — the kind of operational consistency MGMA says practices need across the revenue cycle.

Where tech fits: don’t skip the fundamentals

MGMA noted that many organizations are exploring AI and automation, including documentation tools, to reduce errors and improve the completeness of clinical notes.

Physicians Practice has echoed that technology can help, but only if it reinforces good process: one recent piece on prepayment denials highlighted basics such as timestamping eligibility checks and documenting authorization details, along with using claims-scrubbing tools that can catch payer-edit vulnerabilities before submission.