Faced with an ADR? Read our 11 tips for success
With increasing numbers of Additional Documentation Requests (ADR), home health agencies, and hospice organizations need to produce documentation in a timely manner to prevent claims denials or payment delays. There are many reasons why claims are denied, so it’s important to have a solid understanding of ADR.
Below are 11 tips for success when faced with an ADR:
Become familiar with FISS.
The Fiscal Intermediary Standard System (FISS) is a biller’s best friend. FISS lists all ADRs and their due dates.
Track your ADR.
Keep a running document with all ADRs listed; when they were received, the date you sent documentation back, date the final determination is made, and what the outcome was. With so many specifics around each individual ADR, keeping track is a must.
Mind the clock.
You’ll have forty-five days for a Medicare Administrative Contractor (MAC) to receive your documentation. Equally important, is planning ahead. Regardless of your preferred submission method, be aware of the time it will take to arrive and be sure to keep proof of submission.
Pay attention to detail.
Follow MAC’s checklist for submission, and make it easy for the representative to review and approve your claim. Additionally, it helps to insert page numbers and include a cover sheet that highlights key points. Don’t forget to refer to specific pages for more detail.
Comply with HIPAA.
While submitting anything electronically these days seems more efficient than mailing, be mindful of HIPAA rules. If you submit documentation on a CD, make sure it is password protected.
Know ‘denial’ isn’t final.
You may appeal MAC’s decision, but first, consider whether there is other documentation that you could submit to support your claim. After all, appealing without solid backup or rationale will probably result in denial of your claim.
Look for trends.
Is your organization being hit with the same ADR over and over? Consider this an opportunity to improve how documentation is done at the clinician level to ensure future compliance related to this ADR.
Plan for compliance.
Proactively reviewing claims prior to submission will help achieve positive results when responding to an ADR. Consider some of these strategies:
- Pre-bill reviews: Clinical reviews seek to find if the notes and documentation provided support the claim. While billing reviews aim to see if there is a visit that corresponds to the claim.
- Chart audits: Review major indicators for meeting conditions of participation or condition of payment.
- Peer reviews: Clinicians assist with quality assurance for chart reviews. This is a great learning tool that can identify concerns and opportunities.
Subscribe to this philosophy: if it went in as a data point, it can come out in a report. Leverage your data to pinpoint focus areas for reviews. The goal is for your data to show that you are meeting all criteria related to a specific diagnosis. Something important to consider here is where your staff is documenting. If it’s a post-patient visit, the quality of documentation decreases.
Develop SMART goals.
Once you identify areas for improvement, create goals associated with these focus areas. SMART goals are specific, measurable, attainable, relevant, and timely. Clearly communicate your goals with your staff as they are key stakeholders in whether your claims are approved or denied.
Ensure staff receive the appropriate training on how to document during orientation. Standardizing what each clinician is inputting is key to a streamlined, efficient ADR process and submission. The documentation should speak for itself.
Organizations that rely on paper-based documentation or have to search for information on disparate clinical and financial systems experience a dramatic increase in staff time, productivity loss, and potential for penalties or take-backs. On the other hand, organizations that leverage a modern EMR solution have a greater assurance that patient records and the organization’s record-keeping are compliant with the most current regulations.