DecisionHealth, DecisionHealth - 2021 Issue 10 (October)

First-level appeals drop, but success rate rises for Part B providers, DME

If you’ve been doing better on Medicare appeals lately, you’re part of a trend. Between 2013 and 2020, the overall rate of success for providers and suppliers on redeterminations, the first level of formal Medicare appeals on claims denials, rose from 46.5% to 55% at Part B Medicare administrative contractors (MACs). And Part B durable medical equipment (DME) claimants did even better.

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