Revenue Cycle

CMS update indicates high provider success rate for appealing denials

Recovery Auditor Report, June 24, 2010

A recently released report titled “The Medicare RAC Program: Update to the evaluation of the three-year demonstration,” indicates that providers have been winning more appeals since the last update.

CMS issued this report on June 14 to update information from its last report, issued in January of last year, which included data inclusive of March 27, 2008. The new report, which contains statistics through March 9, 2010, reveals that the number of appeals claims dropped significantly from the 118,051 reported in January, to the 76,073 in the new data. This came as a result of claims no longer being counted individually at each level of appeal, but rather being counted only once if appealed to any level.

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