An appeal writer who scored very highly on a random quality audit of her appeal letters didn’t have the expected success when it came to overturning claim denials. She did well, but not as well as anticipated. What was the reason for the disconnect? The appeal writer was assigned some of the hardest cases to overturn because of her experience and knowledge.
“This is where you really have to dig deep into the cause of the lower-than-expected overturns,” said Denise Wilson, senior vice president of Audit and Appeal Services at AppealMasters in Towson, Maryland, at a Feb. 12 webinar. The best way to stay on top of the cause of denials, the outcome of appeals and the productivity of your appeal writers is to track and trend the data over time and capture it in “meaningful” dashboards.