MDaudit is featured in the Winter 2025 issue of For The Record Magazine in the article titled “Documentation Dilemmas: Stepped-Up Audits Driving Denials.” The piece highlights findings from MDaudit’s 2024 Annual Benchmark Report, revealing a significant increase in clinical documentation audits and associated denials. Specifically, there was a 100% rise in clinical documentation audits, contributing to substantial surges in denials across various healthcare settings: professional (34%), hospital outpatient (84%), and hospital inpatient (148%). These increases were largely due to insufficient documentation supporting claims, with commercial payers’ requests for information denials increasing by 122%.
MDaudit CEO Ritesh Ramesh emphasizes that payers are intensifying scrutiny on high-cost procedures and medications, focusing on overpayments and requiring detailed information on medical necessity and patient treatment. The report, analyzing data from over 650,000 providers and 2,200 facilities, underscores the critical role of comprehensive clinical documentation in mitigating financial risks. Ramesh notes that overreliance on clinical documentation improvement (CDI) tools without adequate human oversight contributes to these challenges, advocating for robust CDI integrity programs to ensure compliance and positive payment outcomes.
Read the full article here: Documentation Dilemmas: Stepped-Up Audits Driving Denials.
