ICD10monitor November 23, 2025
EDITOR’S NOTE: Ritesh Ramesh, CEO for MDaudit, appeared on Monitor Monday to report his company’s findings on nationwide audit trends.
The rate of payer audits accelerated in 2025, with hospital inpatient and outpatient average denial amounts that increased by 14 and 12 percent, respectively.
Denial volumes were also up overall, led by a nearly fivefold increase in Requests for Information (RFIs) and medical necessity denials for Medicare Advantage (MA) plans. The total at-risk amounts, number of claims, and average amount per claim increased by 30 percent in payor audits. Denials related to outpatient coding increased by 26 percent.
These are just a few of the trends identified in the 2025 MDaudit Benchmark Report, a comprehensive examination of real-world claims...
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