One of the easiest problems to solve, but one of the biggest problems existing in long term care is getting industry leaders to recognize the importance of qualified medical records staff. Performing my own, informal root cause analysis this week, I determined that the reason my SNF client was unable to produce a complete medical record for a recent Additional Documentation Request (ADR) was because the medical records staff did not understand what was being asked or expected of them.
Read MoreTopics: Documentation, ADR, Medical Record Review, F-Tags
This issue of Medicare Minute discusses appealing denied claims. Often times the business office will receive notification that a claim has not been payed.
Topics: CMS, Denial Management, ADR
ADDITIONAL DEVELOPMENT REQUESTS (ADR)
Topics: ADR
Additional Development Requests
When a Medicare contractor (MAC) cannot make a coverage or coding determination from the information that has been provided on a claim and its attachments, then the facility may be asked for additional documentation and receive an Additional Development Request (ADR). The MAC requests records related to the claim(s) being reviewed, and may collect documentation related to the patient's condition before and after a service in order to get a more complete picture of the patient's clinical condition.
Topics: ADR, Compliance, RAC Audit
