Documentation received for Non-Medical ADRs will not be accepted or routed to other departments. Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, Medicare ID, facility name and provider number, Document Control Number (DCN) and Date of Service (DOS)
Full Answer
What if I receive a medical review additional documentation request (ADR)?
If you receive a Medical Review Additional Documentation Request (ADR) for one or more claims that you have submitted to Medicare for payment, it is important that you follow these instructions. Provide the documents listed on the ADR and any related physician’s orders.
What is a non-Mr ADR?
A non-MR ADR is generated when additional information is needed for claim adjudication that is unrelated to CGS's medical review activities. Non-MR ADRs are generated in the following situations.
How do I submit my ADR documentation to CGS?
Using myCGS to submit your documentation is also an option. myCGS is a free web portal that allows you to submit your ADR documentation directly to CGS and will help to ensure a timely response to an MR ADR.
What is an ADR letter?
An ADR letter is a letter from the MAC asking for additional information called Additional Development Request. There are different types of reasons. Regardless of the reason, agencies must respond to the request in a certain time frame. The letter will inform the agency of what they are looking for and when to submit the information.
How do I submit my ADR to Medicare?
Upload your ADR response through eServices, our free, self-service portal located on the Palmetto GBA website. eServices lets you upload your ADR response electronically, eliminating the need to fax or mail documents and packages. To participate, you must have an EDI agreement on file with Medicare.
WHAT IS A ADR letter from Medicare?
ABOUT THE ADR LETTER: – When you receive an additional development request (ADR) letter, the Medicare contractor is providing you with a specific list of items billed on the claim and the types of documentation needed to verify that items submitted on your claim meet policy requirements, are coded correctly, and/or are ...
What is a non medical ADR?
A non-MR ADR is generated when additional information is needed for claim adjudication that is unrelated to CGS's medical review activities. Non-MR ADRs are generated in the following situations.
What is additional documentation might a payer request?
An Additional Documentation Request (ADR) is typically a result of a payer's probe or edit, which may be specific to a provider, a service, a payment threshold, a Current Procedural Terminology (CPT) code, or International Classification of Disease, 9th Edition code (ICD-9).
Who is responsible for putting together the necessary information for an additional documentation request ADR )?
Medicare Administrative Contractors (MACs) request medical documentation from the billing provider when the MAC needs more information to make an initial claim determination. The billing provider is responsible for returning the documentation to the MAC within 45 days of the ADR letter date.
What does ADR mean for medical records?
Additional documentation requestAdditional documentation request (ADR)
What is an ADR in home health?
An Additional Development Request (ADR) occurs when the payer of a submitted insurance claim requests that the home health agency (HHA) provide supporting documentation to justify payment for a specific period of service.
How do I submit my ADR to Palmetto?
EventsUpload your ADR response through eServices, our free, self-service portal located on the Palmetto GBA website at www.PalmettoGBA.com/eServices. ... Submit your ADR response via the esMD (Electronic Submission of Medical Documentation) mechanism. ... Fax your ADR responses to (803) 264–8832.Mail your ADR response to:
How do you calculate ADR in medical billing?
Measuring Medical Accounts Receivable: “Days in AR”Compute the average daily charges for the past several months – add up the charges posted for the last six months and divide by the total number of days in those months.Divide the total accounts receivable by the average daily charges.
What agency reviews documentation and billing of Medicare services?
CMS' Center for Program Integrity (CPI) oversees Medicare medical review contractors.
What might trigger a Medicare post-payment audit?
The most common trigger for a post-payment audit is provider profiling and data mining to identify aberrant billing practices and outliers. In addition, post-payment audits can also be triggered by complaints made by patients or employees about the practice.
What is a Medicare post-payment review?
Alternatively, a Medicare postpayment review is the review of claims after they are paid. They can result in a change of payment, meaning that the provider may owe Medicare or a health plan money — or vice versa. Postpayment review strategies include data analysis and medical review.
Can you send ADR in one envelope?
This allows for several ADR response s to be sent in one envelope or package. 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.
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).
Can you fax a full sheet of paper?
To ensure documentation is received properly, fax full sheets of one-sided paper. Do not include half sheets or double sided paper. If document is too large for your facility's fax machine capacity to send all information in one transmission, submit via hard copy or CD.
What is insucient documentation error?
Reviewers determine that claims have insucient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed (that is, the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, or were medically necessary). Reviewers also place claims into this category when a specific documentation element that is required as a condition of payment is missing, such as a physician signature on an order, or a form that is required to be completed in its entirety.
Is CPT copyrighted?
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.