Additional Development Request (ADR)
The denial process starts with an Additional Development Request (ADR). These can be triggered during the billing process with several line items on the UB-04 serving as a catalyst or through coded items on the MDS assessment which is transmitted to the State and Federal database.
Harmony Healthcare International provides one on one assistance to SNF providers with organization of the data to be submitted for an Additional Development Request. Harmony's process is to assist facilities in preparation of the medical record documents for the time frame requested. Harmony provides education for the team in regards to responsibilities and expectations for successful ADR management. The goal of this process is to assure the building is accurately reimbursed for services provided and prevent future unwarranted medical record reviews.
Potential Risk to Providers:
One of the most common reasons an ADR is returned as unfavorable, causing a claim to be denied by the reviewing agency, is a lack of missing documents to support the medical necessity of the claim. Hence it is of utmost importance for the facility to review every note, form, and document submitted for medical review. But an equally important strategy, and one that most providers do not pursue is appealing denied medical claims.
It is important to read the ADR or denial letter thoroughly as the letters will assist the facility in gathering the appropriate information. It is always in the facility’s best interest to discuss the possibility of including additional information not requested that will support the services provided.
The most critical step preparing a medical records for Governmental review is to manage this process with members of the interdisciplinary team. Harmony educates the facility team on managing this meticulous process through on-site seminars, webinars and team coaching sessions.
How can Harmony Healthcare International (HHI) help?
The health care industry is currently experiencing a significant increase in the number of medical review requests from Medicare Administrative Contractors (MACs) around the country. HHI provides our clients with information on how to prepare for a denial free medical review process. Determination decisions are based on the content of the medical record.
Harmony Denied Claim Experts train staff:
- In understanding how documentation supports daily skilled care by both nursing and therapies.
- Review documentation to assess that the submission packet reflects each service coded on the MDS and billed on the UB-04.
- Provide a check list of findings with recommendations for the final document.
- PREP (Proper Reimbursement Explanation Paper): Assists the facility in preparing a statement letter to submit with the requested documentation explaining the rational for the provision of skilled care during the period in question.
- Assists facility leaders in tracking and monitoring all Help Letter activity