An MR ADR is generated by CGS's Medical Review Department to request a provider's medical record documentation for a specific claim. Claims are reviewed to ensure compliance with Medicare's coverage, coding, payment and billing policies.
Why are claims reviewed for Mr ADR?
Claims are reviewed to ensure compliance with Medicare's coverage, coding, payment and billing policies. When a claim is selected for an MR ADR, the claim is moved to the Fiscal Intermediary Standard System (FISS) status/location S B6001 with reason code 39700.
Who can send an ADR?
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. WHY AN ADR? – Any claim submitted to Medicare contractors may be selected for an additional documentation request (ADR).
What is a pre-payment ADR and how do I find it?
A pre-payment ADR is identified in the Fiscal Intermediary Standard System (FISS) with status/location S B6001 (not paid) and Reason Code 39700 (Request for ADR). There are two areas of compliance that the documentation must meet for approval of payment – Technical and Quality of Content.
What is the difference between ADR and ads?
– The terms ADS (Automated Development System) and ADR are sometimes used interchangeably. However, ADR is the appropriate term to cover all requests for additional documentation from Medicare contractors and includes pre- and post-pay. ADS is actually the name of the sub-system used by Medicare contractors.
What does ADR mean for medical records?
Additional documentation requestAdditional documentation request (ADR)
What is an additional documentation development request?
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.
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 respond to an ADR?
Respond to an ADRHardcopy.Fax.Electronically by CD/DVD.Electronic Submission of Medical Documentation (esMD)
What is a Medicare 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.
What does ADR mean in development?
Alternative dispute resolution (ADR), or external dispute resolution (EDR), typically denotes a wide range of dispute resolution processes and techniques that parties can use to settle disputes, with the help of a third party.
What are the 3 types of ADR?
3 Types of Alternative Dispute ResolutionMediation. In mediation, an impartial individual called the “mediator” is brought to help the parties involved in business disputes collaboratively brainstorm resolutions that are mutually acceptable. ... Arbitration. ... Early Neutral Resolution.
What is ADR for Hospice?
Hospices most commonly find themselves dealing with prepayment medical reviews through the Additional Document Request or Additional Development Request (ADR) process initiated by their fiscal intermediary. Typically, these ADRs relate to a particular probe or edit conducted by the intermediary.
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.
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 is an ADR in Medicare?
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.
What is MR ADR?
An MR ADR is generated by CGS's Medical Review Department to request a provider's medical record documentation for a specific claim. Claims are reviewed to ensure compliance with Medicare's coverage, coding, payment and billing policies. When a claim is selected for an MR ADR, the claim is moved to the Fiscal Intermediary Standard System (FISS) status/location S B6001 with reason code 39700.
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).
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.
What does ADR mean in OASIS?
An ADR does not necessarily mean your agency has done anything wrong. Many things outside your agency’s control can trigger these requests, including probes or edits that are service-specific, provider-specific, beneficiary-specific or diagnosis driven. In many cases the OASIS will trigger a frequently-abused HIPPS code.
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:
What do nursing, therapy and medical records need to work together?
Nursing, therapy and medical records will likely need to work together to review and collect the data needed. Carefully review the ADR and note each piece of requested documentation. There’s no better way than an old-fashioned checklist to make certain that you are addressing each request.
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.
