Appeal metrics

Hello,  I am working on developing metrics for our team.  What are you measuring?  We appeal nearly all denials so I don't think appeal success rate would be an accurate measurement.  We have a physician review the quality and clinical merit of the appeal.  Do you have a typical timeframe in which an appeal is written?  If, how do you account for the more difficult appeals, such as clinical validation denial for 6 diagnoses or extended LOS? 


  • We measure outcomes and results of the worked accounts. We do not measure the timeframes involved in the process as there is far too much variance. This is caused by the different types of denial activity as well as payer processes and individual work habits. Overall productivity is measured in how successful the recovery is based on reimbursement collection percentages.

  • Has anyone implemented artificial intelligence or utilized a RPA (Repetitive Process Automation) strategy to respond and prepare denial appeals? If so, what has been your success/fail rate?

  • Thank you for you response.  I am not able to locate any metrics on appeal success rates.  It appears it maybe different for everyone and not standardized in our industry.

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