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Home > Compliance
ADR Response Guide for Home Health Organizations©
ADR Response Guide for Home Health Organizations©
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Description

This guide is designed to assist your organization in preparing for and responding to Additional Development Requests (ADRs). ADR Response Guide for Home Health Organizations© discusses all aspects of the ADR process that your organization can incorporate into your organizational processes.

Features & Benefits:

  • Chapters include: What are ADRs, responding to ADRs, staff roles, compiling the ADR packet, and many more
  • CD with pre-billing audit tools and charge denial calculator
  • References and resources

    Package Includes:

  • Spiral bound guide
  • CD with helpful electronic tools
  • Staff education
  • MS Power Point on CD

    Table of Contents

  • Introduction
  • How to Use this Guide

    Chapter 1: What are Additional Development Requests (ADRs) and Why do They Occur?

  • Why Medical Review?
  • Progressive Corrective Action
  • Probe Edits/Reviews - What are they?
  • Additional Development Requests - What are they?
  • How to Identify ADRs
  • Sample: ADR Notification Letter
  • How to do DDE Look-Up
  • CAHABA Flowchart
  • ADR Tracking Log
  • Organizational Readiness for ADR Processing
  • Presentation: Educate/Prepare Staff for ADRs

    Chapter 2: Responding to ADRs

  • Section 1: Staff Roles
    • Tasks for the Clinician
    • Tasks for the Billing/Clerical Staff
  • Section 2: Clinical Record Review
    • Initial Review of the Clinical Record
    • Pursuit of Further Documentation to Support Eligibility
  • Section 3: Compiling the ADR Response Packet
    • Goals for Compiling the ADR Packet
    • Compiling the ADR Packet
    • Recommended Order of ADR Packet Documents
    • Final Review of ADR Packet—Who, What, How
    • ADR Final Review Checklist
    • "Don‘t Forget" Items
    • Sample: ADR Response Cover Letter
    • Examples of ADR Packet Cover Sheets

    Chapter 3: Prevention and Correction

  • Corrective Education with Staff
  • Proactive Steps to Mitigate Risk

    Chapter 4: Targeted Medical Review

  • Charge Denial Rate (CDR) and How to Calculate
  • Charge Denial Rate (CDR) Calculator
  • Targeted Medical Reviews (TMR) - What is it?
  • What to do if Targeted Medical Review Appears Imminent
  • Steps to Effectively Resolve Probe Edits and TMRs as Quickly as Possible
  • Developing a Corrective Action Plan
  • Sample: Corrective Action Plan Format Letter
  • Establishing an Episode Tracking System
  • Episode Date Calculator with Physician Signature
  • Tracking Log

    Chapter 5: References, Resources, Requirements

  • Listing of MAC Websites and Other Resources
  • Acronym Index
  • Pre-Billing Audit Tool
  • Publication Date: December 2010
    Number of Pages: 91 manual plus CD-ROM
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