decisionhealth Newsletters, Part B News - 2011 Issue 2 (February)
Benchmark of the Week: Success of Medicare Advantage appeals, 2009
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Article Overview
This article reviews 2009 Medicare Advantage second-level appeal results and presents a regional benchmark of reconsideration outcomes using data reported by a CMS contractor. It is useful for billing, coding, and appeals professionals who want to understand how appeal success rates vary by region and how those figures compare with traditional Medicare Part B patterns. The piece focuses on high-level appeal performance metrics and the source of the data rather than claim-level coding detail.
Why This Topic Matters
Appeal success benchmarks can help practices evaluate whether their reconsideration outcomes are typical for their region and payer mix. The article provides context for Medicare Advantage appeals performance using publicly reported 2009 data.
What You Will Learn
- How Medicare Advantage reconsideration outcomes are summarized at a high level
- How regional appeal success benchmarks vary across Medicare Advantage markets
- How the reported Medicare Advantage figures compare with traditional Medicare Part B appeal trends
- What source and data limitations are noted for the benchmark charts
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Appeals specialists
- Practice managers
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