Whitepapers

Impact of Appeals and Grievances (A&G) on Medicare Stars Ratings

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.