| 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 |
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