The top 10 regulatory burdens for medical practices in 2026

The Medical Group Management Association (MGMA) says regulatory and administrative work continues to consume a growing share of practice resources, with audits and appeals topping its 2026 list of physician burdens and Medicare Advantage (MA) accounting for three of the top five.

The group released its 2026 Regulatory Burden Report on April 9, drawing on survey responses from executives representing more than 230 group practices.

Ninety-five percent of responding MGMA members reported an increase in regulatory burden over the past three years, and 40% said they now keep at least three full-time administrative staff per physician on tasks like prior authorization, denials and quality reporting.

“It is no surprise that this year’s MGMA regulatory burden report further illustrates the strain medical practices experience every day,” said Anders Gilberg, senior vice president of MGMA government affairs. He pointed to Medicare Advantage prior authorization, denials and automatic downcoding as the chief drivers, along with quality reporting requirements and other federal mandates.

Medicare Advantage dominates the list

Three of the report’s top five burdens are tied exclusively to MA: prior authorization, denials and automatic downcoding.

Audits and appeals, ranked first overall, are also commonly associated with MA, MGMA noted, citing mandatory Risk Adjustment Data Validation (RADV) audits and the work of contesting denied claims.

Ninety percent of practices reported a shift toward MA, and 79% of those said the change has had a negative impact on operations. Eight percent reported a positive impact and 13% reported no impact. MA now covers more than half of Medicare-eligible beneficiaries.

Some MGMA respondents warned that continued participation may not be sustainable without changes.

“If providers are not promptly paid their negotiated rates and are subject to overly burdensome utilization tactics, participating in MA will become increasingly unsustainable, and practices may decide to end MA contracts,” the report states.

Prior authorization burdens on the rise

Ninety percent of responding practices said prior authorization burden grew in the past 12 months. Members ranked MA as the most burdensome payer for prior authorization, followed by commercial plans, Medicaid and traditional Medicare.

MGMA also flagged the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Service Reduction (WISeR) Model, which extends prior authorization into Traditional Medicare for certain services, as a new pressure point for practices.

One practice executive quoted in the report described adding two staff over the past year to handle the rising volume, bringing the team working full-time on prior authorizations to four.

“This was the only way to ensure prior authorizations were completed on time and to avoid rescheduling patients, since nearly all of our visits require authorization,” the executive said. “As a result, our payroll and overall clinic costs have increased significantly.”

MIPS, staffing and burnout

Sixty-nine percent of practices remain in the Merit-based Incentive Payment System (MIPS), and 86% said quality reporting has added to administrative burden. Just 31% participate in an Advanced Alternative Payment Model (APM), with many citing a lack of clinically relevant options for their specialty.

Seventy-seven percent of respondents named regulatory burden a significant factor in physician burnout. Excessive regulatory and administrative work was the top-ranked contributor to burnout in the survey, ahead of financial stress, electronic health record (EHR) inefficiencies and staffing shortages.

Members linked burnout to longer wait times for appointments, shorter visits, an inability to take on new patients and reduced practice hours.

MGMA’s policy recommendations

MGMA’s recommendations include a comprehensive overhaul of MIPS, a long-term extension of the Advanced APM incentive payment, standardization of electronic prior authorization, increased oversight of MA plans, more federally funded graduate medical education slots, annual Medicare conversion factor updates tied to inflation, and changes to Medicare’s budget neutrality requirements.

“MGMA urges Congress to confront the complexity of government regulations impacting medical groups and strengthen oversight of Medicare Advantage plans to hold insurers accountable for practices that delay care, deny payment and inflate administrative overhead,” Gilberg said.

The full top 10 list also includes EHR interoperability and information blocking, Medicare and Medicaid credentialing, Medicare Advantage contracting and network issues, surprise billing and good faith estimates and HIPAA/cybersecurity.