Understanding the Differences Between Standard and Expedited MA Appeals

The expedited appeals process is an underused strategy for overturning Medicare Advantage pre-service benefit denials, says Brian Moore, M.D., medical director of utilization management and physician advisor services at Atrium Health in North and South Carolina (“Expedited Appeals of MA Benefit Denials Could Be ‘Game-Changer’ for Hospitals,” RMC 28, no. 11). Here’s a CMS flow chart that summarizes the differences between the standard process for provider appeals to MA plans and expedited appeals. Contact Moore at brian.moore@atriumhealth.org.

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