Investigating and analyzing the current status of management accounting application in enterprises is of great practical significance. This paper designs a questionnaire to assess the application, effectiveness, and challenges of management accounting in small and medium-sized enterprises (SMEs) in the Yangtze River Delta region of China. A total of 350 questionnaires were distributed, with 283 returned. After excluding 62 that did not meet the requirements, 176 valid questionnaires were statistically analyzed. The results indicate that while SMEs in the Yangtze River Delta have made some progress in applying management accounting, there is room for improvement in their understanding and application of management accounting methods and tools. These enterprises need to invest more in their management accounting departments and make appropriate transformations to meet the demands of financial transformation.