When a Medicare contractor (MAC) cannot make a coverage or coding determination from the information that has been provided on a claim and its attachments, then the facility may be asked for additional documentation and receive an Additional Development Request (ADR).
What type of ADR does an HHA receive?
Dec 21, 2021 · Additional Development Request (ADR) Overview. In general, an additional development request (ADR) is generated to request documentation from a provider to assist with adjudicating a Medicare claim. CGS generates two types of ADRs for which additional documentation is requested. Medical Review ADR (MR ADR) Non-MR ADR; MR ADRs (Reason …
What is the difference between ADR and ads?
Each Medicare contractor performs data analysis and medical review of records for services billed to the Medicare Trust Fund. In order to obtain records a request is generated known as an additional documentation request (ADR). Medicare contractors send to SNFs, physicians, and suppliers, as a companion to claim payments, a notice of payment, referred to as the …
What is the reason code for mRMR ADR?
An Additional Development Request (ADR), also known as an Additional Document Request, is issued for the purpose of reviewing documentation for specific issues as determined by the Centers for Medicare and Medicaid Services (CMS) or other governing agencies of the federal government. ADRs emanate in part from False Claims Act (FCA) legislation, which originally …
What is an ADR letter and how do I respond?
Jun 04, 2021 · Here are links and images for several of the MACs ADR Checklist (in addition to the list below) CGS ADR Checklist (Home Health and Hospice) Palmetto GBS ADR Checklist PDF. NGS Medicare ADR Checklist. We thought that the CGS Checklist was the cleanest and most concise of the links. Home Health ADR Checklist – Preferred Order.
What are Medicare ADRs?
What is an ADR in home health?
What does ADR mean in medical records?
How do you respond to ADR?
- Hardcopy.
- Fax.
- Electronically by CD/DVD.
- Electronic Submission of Medical Documentation (esMD)
What are the 3 types of ADR?
What should the ADR response package include?
What is an ADR process?
What are the two main types of ADR?
Is ADR a liquid?
How do I submit my ADR?
What is ADR for Hospice?
What is an ADR letter?
WHAT IS AN ADR? – When a claim is selected for review or when additional documentation is needed to complete the claim, an ADR letter is generated requesting documentation and/or medical records be submitted. The response must be submitted within a specified time frame to the requesting contractor identified on the letter for review and payment determination. An ADR may be sent by CGS, Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RAC), Supplemental Medical Review Contractors (SMRCs), the CERT contractor, etc.
Can you use your own cover sheet instead of ADR?
Never use your own cover sheet instead of the ADR letter. Forms you create to use as a cover sheet are not recognized by our system and may result in delays in routing your response appropriately. Using the ADR letter as the cover sheet will facilitate appropriate routing of your response.
Do you need to include half sheets in an ADR letter?
Copies should be full sheets of one-sided paper. Do not include half sheets or double-sided paper. If your facility uses double-sided forms, verify that beneficiary's name is on each sheet of paper submitted. Return all documentation to address and specific Post Office (PO) Box indicated on ADR letter.
Does Noridian accept a CD?
Noridian will only accept CDs/DVDs that are zipped using Adobe Security, WinZip, 7-Zip or Secure Zip. (Other formats will not be accepted and CD/DVD will be returned to provider) Images may be included in one Zip file or in multiple Zip files (for instance if one image per Zip is necessary).
Does each intermediary treat ADRs differently?
Each intermediary treats ADRs slightly differently. It is important to know the standards that your intermediary has set related to when a hospice is placed on targeted medical review, for example. Also, understanding the type of probe that you are in will be important as you respond to the ADRs.
What is the most important strategy for responding to an ADR?
The most important strategy for successfully responding to an ADR is a proactive one–clearly and carefully document the patient’s condition and the services provided so that the documentation submitted with an ADR response leaves no doubt of the patient’s hospice eligibility.
Should hospices send ADR packages?
Although it is a little more work from an administrative perspective, it is always safest to send each ADR response separately, with a separate cover letter. Hospices should also consider sending the packages via overnight delivery or other means by which timely receipt can be assured and tracked.
How to navigate an ADR?
Sometimes, the surest way to navigate an ADR is to turn to an experienced clinical consultant who can guide you through the process, make certain that you include all the key elements needed to support your claim.
How to contact Home Health Solutions about ADR?
If you’d like more information about our ADR services, call us at 888-418-6970 or email:
Does OASIS trigger HIPPS code?
In many cases the OASIS will trigger a frequently-abused HIPPS code. If you really have done your homework, evaluating and scoring your patients according to Medicare’s own definitions and supplementing the OASIS with high quality clinical notes and assessments, your ADR experience is likely to be much less stressful.
