Thirty percent of medical groups audit payer payments against contracted rates every month, according to MGMA's February 2025 Stat poll of 193 practice leaders. Another 18% audit every quarter, so 48% run at least four audits a year.
The monthly share was 9% in MGMA's January 2021 poll of 519 responses and 26% in its January 2023 poll. Audits have become more frequent, but 30% of groups in the 2025 poll still audit only once a year.
Audit frequency in three MGMA polls
MGMA asked the same question in 2021, 2023 and 2025: how often the group audits payer payments against contracted rates.
| Audit frequency | Jan 2021 (519 responses) | Jan 2023 | Feb 2025 (193 responses) |
|---|---|---|---|
| Monthly | 9% | 26% | 30% |
| Quarterly | 10% | 15% | 18% |
| Semiannually | 9% | 10% | not reported |
| Annually | 47% | 25% | 30% |
| Never | 25% | 24% | not reported |
| Other | not reported | not reported | 23% |
Source: MGMA Stat polls of January 5, 2021, January 17, 2023 and February 11, 2025. MGMA did not state the 2023 response count.
The monthly share rose 21 points from 2021 to 2025 (30% minus 9%). Groups that audit monthly or quarterly went from 19% in 2021 to 41% in 2023 and 48% in 2025. These sums come from the published answer shares.
The 2021 article also reports that 28% of groups audited more often than once a year, counting monthly, quarterly and semiannual schedules. The same count for 2023 is 51% (26% plus 15% plus 10%). The 2025 poll did not report a semiannual share, so the two-year comparison uses monthly and quarterly only.
Annual-only auditing fell from 47% to 25% between 2021 and 2023, then rose to 30% in 2025. Groups that never audited were 25% of respondents in 2021 and 24% in 2023. MGMA's 2025 write-up gives no "never" share.
The schedule sets how long an error stays hidden. Over one year, a monthly schedule means 12 audits, a quarterly schedule 4, a semiannual schedule 2 and an annual schedule 1. A payer that applies a wrong rate right after a contract change is caught within about 1 month under the first schedule and up to 12 months under the last.
In the 2025 poll, 52% of respondents sit outside the monthly and quarterly groups. They audit annually (30%) or on another schedule (23%). MGMA's published shares add to 53% because of rounding.
How often groups review the contracts themselves
An audit checks what a payer paid against the contract. A contract review checks the contract. In MGMA's August 2023 poll of 389 responses, 58% of groups reviewed payer contracts once a year. Nearly 1 in 10 reviewed them several times a year, 17% had no regular review, and 16% chose "other."
MGMA's December 30, 2025 poll asked about Transparency in Coverage data, the public payer rate files. Only 18% of groups used that data in negotiations. Another 46% did not, and 36% were unsure. That leaves 82% of groups with no use of the files to date.
MGMA's August 25, 2026 poll of 203 responses covered rate timing. Half of the groups (50%) said their last commercial rate increase came three or more years ago. Another 17% said one to two years ago, and 29% said within the past year. MGMA counts two-thirds of respondents (17% plus 50%) as more than a year past their last increase. More than 8 in 10 groups reported higher operating costs year to date. When a rate has not moved in three years, the payment against that rate is the one figure a group can check on its own.
Claim quality sets a limit on what an audit finds
An audit covers claims a payer paid. A denied claim has no payment to compare with the contract, so denials need their own tracking. Experian Health's State of Claims: 2025 report gives figures on that side.
In the Experian report, 68% of providers say a clean claim is harder to submit than a year ago. The same share (68%) say inaccurate or incomplete patient data at intake drives denials. Reducing denials is a priority for 82% of organizations, and 59% plan to invest in denial reduction technology within six months. Only 56% believe their current claims technology meets revenue cycle demands.
Experian also reports that 90% of denials are reworked with at least some human review before resubmission. That review time is the same staff time an audit needs. The report does not state a sample size or fielding dates.
What MGMA includes in an audit plan
MGMA's August 2023 contract article advises building fee schedules at the CPT level for the codes that produce at least 80% of revenue. It also advises pulling one full year of payer mix and gross collections data and focusing rate proposals on the top 3 payers.
MGMA's August 2026 article adds a timing rule: spot-check high-volume codes within 60 days after new rates take effect. The 2025 article names three schedules, monthly, quarterly or semiannual, and ties the choice to the group's capacity.
The January 2023 article by Cristy Good, MPH, MBA, CPC, CMPE, lists five audit strategies and eight revenue cycle KPIs, including days in A/R, claim denial rate and clean claim rate.
Sources
- MGMA, Regular auditing of payer payments, February 12, 2025
- MGMA, Amid inflated expenses, make sure you're regularly auditing payments against contracted rates, January 18, 2023
- MGMA, New year's resolution: Optimizing audits of your medical practice's payer contracted rates, January 7, 2021
- MGMA, Is it time to review your medical group's payer contracts?, August 16, 2023
- MGMA, Most medical groups have gone years without a commercial payer rate increase, August 26, 2026
- Experian Health, The State of Claims: 2025
Talk to us
Fifteen minutes about your practice and the systems you run.