DecisionHealth, DecisionHealth - 2010 Issue 7 (July)

Benchmark of the Week: How MAC transitions affect denial rates

Summary: These charts examine how Medicare claims denials are affected by the transition from carriers to the new Medicare administrative contractor (MAC) system, based on the most recent CMS data available. Few MAC transitions were complete by 2008, though MAC jurisdictions 4 and 5 (Texas and Nebraska) were transitioned in early 2008. Claims data from 2006 was chosen as the "starting" data because no MAC transitions anywhere took place until March 2007 (PBN 8/7/06). NOTE: Transitions for J4 and J5 did not end until a few months into 2008, but because CMS claims data cannot be broken down by month, the 2008 denials reflect a combination of mostly post-transition claims and some claims processed by legacy carriers.

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