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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