The Centers for Medicare and Medicaid Services (CMS) provides Appeals and Grievances (A&G) rights to members and providers associated with a health plan in the Medicare system. This process has a substantial impact on the Medicare Stars Rating System, which measures the quality and performance of Medicare Advantage (MA) plans. All 28 measures, included in the MA plan Stars Rating system, have an associated weight that varies from 1 to 5 in value. The higher the weight, the more the impact of that measure on the MA plan Stars rating. The total weight of all 28 measures was 67. A&G directly or indirectly impact 9 of these 28 measures. These 9 measures have an aggregated weight of 36, which means A&G process has an over 50% (36 out of 67) impact on the overall Medicare Stars Rating.
Optimizing the A&G process, leveraging technology solutions, and focusing on member satisfaction and timely resolution of appeals and grievances are crucial for improving the Medicare Stars Rating of MA plans.
To learn more about how to efficiently execute the A&G process to maintain and improve Medicare Stars Ratings, read the detailed whitepaper.