An August 25 MGMA Stat poll put a number on something billing leaders have felt for years: half of medical groups say their most recent commercial payer rate increase came three or more years ago. Only 29 percent received an increase within the past year. Meanwhile, the same poll notes more than 8 in 10 groups report higher operating costs this year, while fewer than half report revenue growth to match.
That spread - costs compounding annually against fee schedules frozen for three-plus years - is the defining squeeze on practice margins in 2026. Repricing a contract takes months and market leverage most groups lack. But there is a second lever sitting closer to home: how much of the revenue the existing rates promise actually gets collected. When the top line is capped, collection efficiency stops being an operational nicety and becomes the margin.
Why rates stay frozen, and why denials make it worse
MGMA's own analysis identifies the mechanics, and they are mostly passive. Most commercial contracts renew automatically; if nobody tracks the dates and opens the negotiation, another year passes at the old rates. The system defaults to the frozen rate, not the negotiated one. In a 2023 poll, 58 percent of groups reviewed contracts annually, but 17 percent had no regular review schedule at all. And when groups do negotiate, they rarely bring data: only 18 percent have used Transparency in Coverage files in payer negotiations, per a December 2025 MGMA poll, largely because turning those enormous public files into CPT-level comparisons is genuinely hard.
Underpayment compounds at the claim level too. A frozen rate means every avoidable denial, every day of AR, and every write-off is a larger percentage of real margin than it would be at current rates. Payers are also adjudicating faster and denying more precisely, so the gap between billed and collected widens through operational drift, not just pricing. The practices hurt most by frozen rates are the ones whose follow-up is also slowest, and the two losses stack: a payer that pays slowly at an old rate costs more per claim than the same behavior at a current one. Nothing in the contract fixes this. Only the collection workflow does.
What sharper collection looks like when pricing is off the table
- Recover the contractual rate, every time. Underpayment audits routinely find claims paid below the contracted fee schedule that nobody caught. If the rate is frozen, the contracted rate is the ceiling, and leaving pieces of it uncollected is pure loss.
- Attack the denial rate you control. MGMA benchmarking puts first-submission denials at 7 to 8 percent industry-wide, with top performers below 5 percent. On frozen rates, that three-point spread is a bigger share of margin than it would be anywhere else.
- Shorten AR days. Cash today funds next year's cost increases. Every day shaved off AR is working capital recovered without renegotiating anything.
- Build the rate case with your own data. Denials, underpayments, and AR aging by payer are negotiating evidence. The group that arrives with six months of documented payer friction has a stronger position than the one asking politely on contract-renewal day.
There is also a compounding effect worth naming. Practices that collect efficiently generate better data - clean remittances, accurate posting, per-payer underpayment records - and that data is exactly what a rate negotiation requires. The organization that fixes its collection layer is not just protecting margin at frozen rates; it is building the evidence file that eventually moves the rates. Operational discipline and pricing leverage are the same project on different timelines.
The groups that did secure increases within the past year, per MGMA's respondent comments, shared recognizable ingredients: market position, benchmarking data, quality metrics, and willingness to escalate. Notably, none of those ingredients are billing tactics - but all of them are funded by margin, and margin at frozen rates comes from collection discipline. The order of operations matters: fix the collection layer first, then walk into the negotiation with both better numbers and more runway.
The takeaway
Half the industry is working from fee schedules set three or more years ago, and contract repricing will not fix that quickly for anyone. What responds immediately is the collection layer: capturing every contracted dollar, preventing the denials that erode frozen margins, and keeping AR tight so cash arrives while it still covers this year's costs. That is the work QHB automates - daily follow-up, denial prevention, and posting that reconciles against the contract - because when rates are frozen, operational discipline is the only growth lever left.