Harmony Healthcare Blog

Medicare ADR

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 02, 2010

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Edited by Kris Mastrangelo

What Is An ADR?

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 remittance advice (RA). RAs explain the payment and any adjustment(s) made during claim adjudication. This system is also used for the generation of ADRs.

When responding to an ADR providers are encouraged to verify the address for return of records by visiting the Medicare contractor website. NOTE: Return of records in response to an ADR is within 30 days of generation of the request. On day 45 an automated denial of 56900 is attached to the claim.

Each ARD provides the facility with an opportunity to provide the Contrator with the information they need to pay a claim.
Harmony recommends the following steps to ensure a thoroughly prepared ADR packet aimed at solidifying payment for services rendered.
Read the ADR notice carefully and provide every piece of requested documentation.
Consider providing additional documentation that will support payment of the claim.  Physician certifications signed and dated are often not on the list of requested documentation in an ADR.  This is the example of a document that the SNF should add to the ADR packet.
Know the ADR due date.  Mark the due date on a calendar and inform the team. Set a target date for mailing the complete ADR packet at least 10 days prior to the due date to ensure timely arrival at the Medicare Contractor.
Prepare the ADR packet using a team approach.  Rehab, nursing, MDS and medical records are the core disciplines involved in data collection and review of the ADR packet.
Have an outside set of eyes review the packet to determine if there are any exposure areas putting the claim at risk for denial.
Arrange the ADR packet in order of requested documents on the ADR notice.  Highlight pertinent information in the packet so that skilled areas identifiable for the reviewer.
Keep a copy of all documents sent to the Contractor for future reference.
Harmony has a Denial Management service designed to support our customers through this process.


Complete Guide to Successfully Avoiding Denied Claims




Tags: ADR, Compliance

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