Quarterly benchmark · 2026-04-30Overview
The Q1 2026 State of RCM report synthesizes the most recent MGMA and HFMA benchmark surveys with anonymized production data from Medonix's founding U.S. client cohort. Every metric is sourced and labeled so MGMA / HFMA published figures and Medonix cohort observations are kept separate.
The headline benchmark for Q1: MGMA reports the top-performer first-pass clean-claim rate at 95%+, with the industry median in the high 80s, a spread that points to systemic operational variance, not specialty difficulty.
Denial mix has shifted against CO-197 (precertification / prior-auth absent), up year over year and concentrated in cardiology, orthopedics, and behavioral health (HFMA Q1 commentary). CO-16 (information missing) has ticked down as clearinghouse-level scrubs improve industry-wide.
Key findings
- ✓MGMA top-performer clean-claim rate sits at 95%+; the industry median is in the high 80s. The gap is operational, not structural.
- ✓CO-197 (prior-auth absent) denials are the fastest-growing category YoY, concentrated in cardiology, orthopedics, and behavioral health.
- ✓HFMA best-in-class days-in-A/R holds under 30 days; the industry median runs in the high 30s to low 40s.
- ✓Patient-pay collection rate at 28-day statement cadence outperforms 60-day cadence by a wide margin in HFMA cohort data.
- ✓Specialty-level clean-claim variance is now wider than payer-mix variance. The operational story dominates the structural story.
What is in the report
- First-pass clean-claim rate by specialty (top 35)
- Days in A/R by payer type and tier
- Denial mix by CARC code, with quarter-over-quarter shift
- Prior-auth turnaround time by payer
- Patient-pay collection rate by statement cadence
Methodology
Industry benchmarks sourced from MGMA Annual Benchmark Survey and HFMA Revenue Cycle Index, latest available editions. Medonix cohort observations drawn from anonymized production claim records across our founding U.S. client cohort, January 1, 2025 through March 31, 2026. Anonymization follows HIPAA Safe Harbor + expert determination. Industry figures and cohort figures are reported separately throughout. Full methodology in the Medonix RCM Methodology Paper, 2026 Edition.
Citation: Medonix Research, "State of RCM, Q1 2026," 2026.