Running your own home health or hospice agency comes with a lot of requirements—some you can plan on, and some that might just take you by surprise. It’s those “surprise” requirements that can be the hardest to handle. After all, the planned trainings and surveys and tests can all be scheduled. You can prepare. When you get an ADR, also known as an Additional Development Request or an Additional Documentation Request, they might just come out of the blue.
ADRs are, unfortunately, no longer a rare occurrence. Home health agencies are finding that they receive the dreaded ADRs frequently. Although they can be stressful to deal with, there are a few tips and tricks to getting them submitted more smoothly, so your facility doesn’t have to worry about rejected claims.
What Is an ADR?
If this is your first time receiving an ADR, you’re probably wondering how this all works. Home health agencies may receive an ADR after submitting a claim to a Medicare contractor. The Medicare Administrative Contractor (MAC) will issue an ADR if they require additional documentation or medical records to accept the claim.
Additional documentation is usually necessary to confirm that the items within your claim meet policy requirements and Medicare guidelines. Your MAC must receive the ADR no later than forty-five calendar days after the request was issued. That’s why timeliness is essential when it comes to ADRs.
If you don’t submit ADR materials on time or you don’t include all of the requested documentation, then you risk your claim being denied. Claims can be reopened after denial, but it’s best to avoid the extra trouble if possible.
How Do I Respond to an ADR?
Make sure you read the request very carefully so that you understand which materials you need to send. You must turn in ALL of the requested documents, and in the proper formats (by mail, fax, secure internet). Be sure to only submit clear copies of documents, not original documentation.
Also know your MAC’s preferences on cover sheets and other organizational details. If you’ve received more than one ADR from the same MAC, do not combine responses. Submit each ADR response individually.
Working with ADRs can be confusing, and that’s why Forte Consulting is here to make it easier. You have a home health agency to run! You have a hospice care business to keep on track. There is no shame in reaching out to a consultant to help you through the surprise requirements so that you can keep working on the aspects of your business that you do best. Our top-notch healthcare consultants can guide you through the process of responding to ADRs and getting your claims accepted. Reach out to us today to see how we can help.
