Grand View Research estimates the U.S. medical billing outsourcing market at $7.73 billion in 2026. Yet in a separate late-2025 Tebra survey, 54% of billing firms expected gross margins of 10% or less for 2025. These sources describe different populations, but together they frame a useful business question: how does demand for billing services translate into stronger operating performance?
Medical billing industry statistics cover the market for services, the firms doing the work, and providers’ success in collecting payment. Read together, with their definitions intact, they show why market growth can coexist with narrow company margins. Payment also deserves attention beyond the initial claim decision: Kodiak’s latest analysis found that lower overall denial rates did not translate into better cash performance in its provider dataset.
This compilation covers U.S. billing operations, with global market estimates shown separately. It draws on evidence available as of September 26, 2026, including surveys, government statistics, commercial forecasts, and operational benchmarks. Underlying data years vary; a report carrying a 2026 title does not necessarily measure activity during 2026.
Key medical billing industry statistics
| Finding | Period and population | Source |
|---|---|---|
| The U.S. medical billing outsourcing market was estimated at $6.95 billion. | 2025; GVR’s U.S. market model, including in-house and outsourced components | Grand View Research |
| 54% of surveyed billing firms expected gross margins of 10% or less. | 2025 expectations, reported in December 2025 | Tebra |
| 41% of respondents reported claim denial rates of 10% or higher. | June–July 2025; surveyed healthcare decision-makers | Experian Health |
| Full automation offers an estimated $21 billion remaining savings opportunity. | 2025 Index, using 2024 data; selected U.S. medical and dental transactions | CAQH and DataSpring |
| 82% of surveyed patients said accurate estimates helped them prepare to pay. | State of Patient Access 2026; patient respondents | Experian Health |
| Payer takebacks equaled 1.57% of accounts receivable. | First half of 2026; providers in Kodiak’s platform dataset | Kodiak Solutions |
Medical billing market size and growth
Grand View Research estimates the U.S. medical billing outsourcing market at $6.95 billion in 2025, with a $7.73 billion estimate for 2026. Its corresponding global model places the market at $16.6 billion in 2025 and $18.5 billion in 2026. These are commercial market estimates, with geography and scope defined by the publisher.
| GVR market series | 2025 estimate | 2026 estimate | 2033 forecast | Forecast CAGR for 2026–2033 |
|---|---|---|---|---|
| United States | $6.95 billion | $7.73 billion | $17.69 billion | 12.56% |
| Global | $16.6 billion | $18.5 billion | $45.3 billion | 13.6% |
All values are U.S. dollars. CAGR means compound annual growth rate and describes the publisher’s projected growth over the stated interval. The 2033 amounts are forecasts, not revenue already earned or guaranteed future outcomes.
The market label needs particular care. Both GVR reports include in-house and outsourced components in their public segmentation. Their headline totals therefore should not be treated as a census of sales earned solely by third-party billing companies. The public summaries establish what GVR reports; they do not provide enough access to independently reproduce its proprietary models.
For business planning, these estimates provide scale and an attributed growth outlook. They cannot establish how much revenue an individual firm can capture, what its margins will be, or how much a practice would save by outsourcing. Those questions require company and operating data.
Billing outsourcing also should not be used interchangeably with the broader revenue cycle management (RCM) market. RCM covers the wider process of managing payment, from early patient and insurance information through collection. Keeping the market boundary explicit avoids combining unlike estimates into an apparently larger industry total.
Billing company performance from revenue to claim acceptance
Tebra’s 2026 billing benchmark report draws on a December 1–17, 2025 survey of 190 U.S. professionals. Its introduction describes participants across billing companies and medical practices. This is a vendor-sponsored, mixed-role sample with substantial small-firm representation, rather than a census of U.S. billing businesses.
Most surveyed firms expected gross margins of 10 percent or less
Three findings help explain the operating picture within that sample:
- 68% of surveyed firms reported annual revenue below $500,000. The revenue table concerns 2024, even though respondents were surveyed in late 2025.
- 54% expected gross margins of 10% or less for 2025. This is an expectation about gross margin, not a measurement of realized net profit.
- Median first-pass claim acceptance was 85%. This is a self-reported submission benchmark, not the percentage of billed revenue eventually collected.
The small-firm revenue mix helps readers judge where these findings are most relevant. It does not establish the size distribution of every billing business nationally. Similarly, the margin result describes how respondents expected their businesses to perform; it is not an industry-wide average profit margin.
First-pass acceptance belongs at a different stage of the process from payment. A claim accepted for processing can still face later adjudication or payment issues. Conversely, a submission that does not pass initially may be corrected. The 85% median therefore cannot support a claim that the remaining 15% of claims, or revenue, will be permanently lost.
Together, the measures give operators distinct questions to track: how much business the firm handles, what it retains after costs, and how smoothly claims enter processing. A favorable answer to one does not settle the others. For an internal review, place acceptance alongside eventual payment and the work needed to resolve unsuccessful submissions. That makes it easier to assess whether smoother submission performance is accompanied by stronger financial results.
Claim denial and billing data statistics
There is no single universal all-payer medical claim denial rate established by the evidence reviewed here. Available findings measure different populations and stages: respondents describing their organizations, insurers reporting claim outcomes, or providers measuring denied dollars. Their percentages cannot be averaged into one national benchmark.
Two provider surveys give different views of denial pressure
Experian Health’s State of Claims 2025 survey included 250 financial, billing, and claims decision-makers, with fieldwork from June 23 to July 3, 2025. It found that:
- 41% reported denial rates of 10% or higher. The 41% measures respondents whose organizations met that threshold; it is not the share of all claims denied.
- 54% said claim errors were increasing. That measures a reported direction of change, not the fraction of claims containing errors.
- 50% identified missing or inaccurate claim data among leading denial triggers. It does not establish that half of denied claims had that cause.
A separate Experian survey of 200 healthcare leaders, conducted in January–February 2026, found that 24% reported increasing denial rates, while 47% reported decreases. The different questionnaire and sample prevent treating this as a directly comparable annual wave of State of Claims.
The newer findings complicate a blanket claim that denials are worsening everywhere. They do not prove a nationwide improvement either. For a provider comparing its own results, matching the payer population, reporting period, and metric definition is more useful than choosing whichever published percentage looks closest. The same principle applies when evaluating progress internally: compare equivalent periods and payer groups, then examine both the frequency of denials and their dollar value. These answer different questions about workload and financial exposure.
Marketplace insurers denied 19 percent of reported in network claims
KFF’s analysis of 2024 HealthCare.gov insurer reporting, published in March 2026, found denial rates of 19% for in-network claims and 37% for out-of-network claims. These results concern reporting Marketplace insurers and post-service medical and prescription claims. They are not averages for all U.S. insurance.
The reported denial rate excludes initially denied claims later resubmitted and paid. KFF also notes complications when a new claim replaces a denied original. That makes these figures unsuitable as a national initial-denial benchmark.
Consumers appealed fewer than 1% of denied claims, and insurers upheld 66% of internal appeals in that dataset. Consumer appeals are distinct from provider corrections and resubmissions. Low consumer appeal frequency does not demonstrate that providers abandoned the claims or that all denied balances became patient debt.
| Measure | What the percentage counts | Stage or scope |
|---|---|---|
| Experian’s 41% | Survey respondents reporting denial rates of at least 10% | Respondent-reported organizational experience in 2025 |
| KFF’s 19% in-network rate | Denied claims within the reported claim universe | 2024 Marketplace reporting; excludes initially denied claims later resubmitted and paid |
| Kodiak’s 2.89% commercial final denials | Denied dollars relative to accounts receivable | Commercial final-denial measure for the first half of 2026 |
These distinctions also matter when reviewing internal dashboards. A first-pass acceptance measure should retain the system’s own definition; relabeling its complement as a denial rate can obscure where the problem occurs. Submission acceptance, a payer’s decision, and eventual payment should remain separately identified.
Automation and AI in medical billing
The remaining savings opportunity from transaction automation
The 2025 CAQH Index release, published by DataSpring in February 2026, estimates that electronic transactions and improved data exchange avoided $258 billion in U.S. healthcare administrative costs in 2024. It identifies a further $21 billion savings opportunity from fully automating manual and partly manual transactions.
The first number is modeled cost avoidance relative to alternative transaction handling. The second is estimated remaining potential. They should not be added together as new annual cash savings, billing-industry revenue, or money that one company can recover.
The Index covers selected administrative transactions across medical and dental care. Its release describes participation from more than 600 provider organizations and health plans, representing 63% of insured lives. The detailed methodology is account-gated, so the release-level figures should retain their modeled status. CAQH and DataSpring
In Experian’s separate 2026 survey, 49% of healthcare leaders said automation had its greatest impact in front-end registration and verification. This is a perception of where automation helps, rather than a measured financial return. It makes front-end work a useful area to examine, without establishing the savings a particular organization would achieve. An organization can use this finding to choose a process for investigation, then evaluate its own transaction volume, manual effort, and correction work before building a savings estimate.
AI adoption depends on the task and organization
Electronic transaction processing is not automatically artificial intelligence. Even among AI measures, a billing firm adopting any AI and a hospital using AI specifically to reduce denials answer different questions.
| Population and source | Use being measured | Report or fieldwork period | Finding |
|---|---|---|---|
| Billing firms in Tebra’s survey | Any AI adoption | December 2025 fieldwork | 59% reported no adoption |
| Healthcare respondents in Experian’s claims survey | AI to reduce denials | June–July 2025 fieldwork | 14% reported use |
| Participating health plans in the CAQH Index | AI in administrative workflows | 2025 Index; released February 2026 | More than 50% reported use |
| Participating provider organizations in the CAQH Index | AI in administrative workflows | 2025 Index; released February 2026 | 25% reported use |
The CAQH release does not specify separate AI fieldwork dates. These figures describe different populations and applications, so they do not form an adoption ranking or a time series.
Tebra also reports that 71% of automation adopters described improved efficiency. Its public wording links the finding to targeted automation; the subgroup size is not disclosed. This is neither an AI-only effect estimate nor a 71% productivity gain. Adoption, perceived improvement, and a measured return on investment remain separate claims.
For readers evaluating automation, the practical next step is to define what success would mean in their own workflow:
- Task: Identify the specific activity being automated, such as registration or verification, rather than treating AI adoption as an outcome.
- Baseline: Record the time, errors, and correction work associated with the existing process.
- Observed result: Compare the same measures after implementation, accounting for changes in volume and case mix.
- Human review: Include exception handling, quality checks, and remaining staff effort when assessing the result.
This is an evaluation framework, not a set of outcomes established by the cited surveys. It connects the adoption figures to a business decision without turning reported enthusiasm into a savings forecast.
Patient payments and the revenue providers actually retain
Patient payment and insurer payment create different questions for a billing operation. The Centers for Medicare and Medicaid Services reports $556.6 billion in U.S. out-of-pocket health spending in 2024, representing 11% of national health expenditure. This measures spending, not unpaid medical bills or debt.
In Experian’s State of Patient Access 2026 findings, 82% of surveyed patients said accurate estimates helped them prepare to pay healthcare costs. The report draws on more than 1,000 patients and over 200 healthcare revenue cycle leaders. Detailed recruitment, fieldwork dates, and weighting were not established from the public summary.
The result supports attention to cost clarity before payment. It does not quantify an increase in collections or prove that a prepared patient can afford the eventual bill. Payment preparedness and actual collection outcomes need separate measures. For a billing team, that means reviewing the patient’s understanding of the expected cost alongside whether payment was completed. A favorable experience with an estimate answers the first question more directly than the second.
Payer takebacks increased after payment
A different dataset shows why receipt of payment is not always the endpoint. Kodiak Solutions’ September 2026 analysis covers proprietary platform data described as representing more than 2,300 hospitals and 375,000 physicians. Payer takebacks, or recoupments of money already paid, rose relative to accounts receivable (A/R).
| Kodiak platform measure | First half of 2025 | First half of 2026 |
|---|---|---|
| Overall payer takebacks as a share of A/R | 1.38% | 1.57% |
For commercial payers specifically, final denials reached 2.89% of A/R, while takebacks reached 2.25% of A/R in the first half of 2026. Those payer-specific figures should remain separate from the overall takeback measure. Kodiak
Kodiak reported that improvements in overall initial and final denials did not translate into better cash performance. Its release supports a useful operational distinction: progress getting claims paid does not guarantee improvement in revenue retained after recoupments. The figures are dollar-based platform benchmarks, not claim-count percentages or nationally representative rates. Detailed weighting was unavailable from the accessible release.
The operational implication is to follow payment beyond the first receipt. Reviewing denials alongside subsequent recoupments and amounts recovered gives a fuller view of collection performance. That is particularly useful when a headline denial measure improves: the next question is whether the improvement also appears in the money ultimately retained. This interpretation does not establish why an individual payer recouped a payment or whether a particular recoupment was justified.
Medical billing workforce and staffing context
43% of respondents reported understaffing in Experian’s 2025 claims survey. That identifies a pressure experienced by surveyed organizations; it does not mean 43% of billing jobs were vacant.
For adjacent national workforce context, the U.S. Bureau of Labor Statistics reports the following for medical records specialists:
- $51,140 median annual wage in May 2025. The occupational wage estimate excludes self-employed workers.
- About 200,700 jobs in 2025. This includes records and coding responsibilities and does not isolate medical billers.
- 8% projected employment growth from 2025 to 2035, with about 14,000 openings per year on average. Openings include replacements for people who change occupations or leave the labor force.
These figures provide a broader labor-market reference, not a billing-company headcount or a biller-specific salary benchmark. The survey and BLS profile describe different populations, so their results cannot be combined to calculate a national staffing shortfall. For employers, replacement openings must also remain distinct from newly created positions. Neither the growth projection nor the staffing survey establishes how many additional employees an individual billing business will need.
Use the national figures as context for a local staffing review, then examine the team’s own workload, unresolved claims, and time spent on corrections. That keeps hiring decisions connected to the work the organization needs completed while preserving the broader employment outlook.
References
1. Grand View Research. Medical Billing Outsourcing Market, 2026–2033 edition. Data: 2025 base estimate, 2026 estimate, and forecasts through 2033. https://www.grandviewresearch.com/industry-analysis/medical-billing-outsourcing-market
2. Grand View Research. U.S. Medical Billing Outsourcing Market, 2026–2033 edition. Data: 2025 base estimate, 2026 estimate, and forecasts through 2033. https://www.grandviewresearch.com/industry-analysis/us-medical-billing-outsourcing-market
3. Centers for Medicare and Medicaid Services. National Health Expenditure Fact Sheet. Data: 2024 historical national health expenditure estimates. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
4. Tebra. The 2026 Billing Benchmark Report. Fieldwork: December 1–17, 2025; annual revenue table: 2024; margin expectations: 2025. https://www.tebra.com/ebook/bp-bc26-the-state-of-the-us-medical-billing-industry
5. Experian Health. Third Annual State of Claims Survey release, September 22, 2025. Fieldwork: June 23–July 3, 2025. https://www.experianplc.com/newsroom/press-releases/2025/experian-health-s-3rd-annual-state-of-claims-survey-finds-denial
6. Experian Health. State of Claims 2025 analysis, September 23, 2025. Data: 2025 survey; additional context for AI use. https://www.experian.com/blogs/healthcare/state-of-claims-2025/
7. KFF. Claims Denials and Appeals in ACA Marketplace Plans in 2024, March 24, 2026. Data: 2024 HealthCare.gov insurer reporting. https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/
8. Experian Health. Claims Denial Management: A Front-End Data Quality Story, 2026. Fieldwork: January–February 2026. https://www.experian.com/content/dam/marketing/na/healthcare/articles/eh_claim_denial_infographic_final.pdf
9. CAQH and DataSpring. 2025 CAQH Index release, February 19, 2026. Cost data: 2024; separate AI fieldwork dates not specified in the release. https://www.dataspring.com/blog/2025-caqh-index-shows-u.s.-healthcare-avoided-258-billion-and-accelerated-automation-interoperability-and-ai-adoption
10. U.S. Bureau of Labor Statistics. Medical Records Specialists, updated August 27, 2026. Data: May 2025 wages, 2025 employment, and 2025–2035 projections. https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm
11. Experian Health. State of Patient Access 2026, public report summary. Fieldwork dates not specified in the accessible summary. https://www.experian.com/healthcare/resources-insights/thought-leadership/white-papers-insights/state-of-patient-access-survey-2
12. Kodiak Solutions. Unyielding Denials analysis, issuer release via Business Wire, September 15, 2026. Data: first half of 2026 versus first half of 2025. https://www.businesswire.com/news/home/20260915724994/en/
