Additional Development Requests (ADRs) are a fact of life for home health agencies. Since CMS renewed its Probe and Educate, now called Targeted Probe and Educate (TPE), preventing ADRs and responding to them in a timely fashion is even more important to the financial health of your agency.
Common causes of home health claim ADRs are missing or illegible signatures, missing or incomplete initial certification or recertification, Face-to-Face Encounter failed to support all elements of eligibility, problems with the OASIS, and lack of documentation to support medical necessity.
There’s no magic shield for defending your agency against ADRs, but you can take steps to protect yourself by identifying certain triggers and being proactive. As in many business settings, simple communication and workflow processes are the key to success. Make sure you have processes and tools in place to:
- Ensure your staff, including physicians, have ongoing education about proper documentation and any new regulations that may impact daily activities.
- Use a team approach to addressing claims and ensuring clear documentation by using a revenue cycle management system that allows notes posting. This helps foster communication between clinicians and your billing team and creates a claim communication trail.
- Monitor Medicare claims throughout their journey to adjudication.
- Track and analyze RAPs, RAPs at risk and canceled RAPs.
- Communicate which claims should be marked for follow up and establish concrete follow up workflows.
eSolutions has developed a handy Home Health Final Claims Checklist that helps ensure you’re submitting your final claim correctly to avoid an ADR and speed up reimbursement.
Need more help with ADRs? eSolutions’ Medicare Enterprise Package includes specialized tools and features developed just for the home health industry. This includes products that help you verify eligibility, examine what’s happening with your claims inside Medicare, electronically submit ADR documentation, easily fix and edit claims, scrub and submit your OASIS files, track RAPs, manage denials and much more! Let us help you prevent ADRs!