Additional Document Requests (ADRs) Management & Support Services
ADR Readiness for Your Skilled Nursing Facility
For the long-term post-acute care (LTPAC) industry, scrutiny of provider claims has steadily increased by government and commercial payers through targeted claim review programs. Their increasingly aggressive efforts are a result of rising concerns with improper payments, fraudulent billing activity and quality of care.
Failure to respond to ADRs or not responding timely can be costly to your facility’s bottom line—and open the floodgates to further audits, and bigger headaches. To avoid this vicious cycle, keep your facility in compliance by responding to ADRs in a timely and complete manner the first time around. With proper planning and a knowledgeable, dedicated team, your facility will never break a sweat when an ADR lands on your doorstep.
Introduction to ADRs & Revenue Recovery Audits
An ADR (Additional Document Request), also known as an Additional Developmental Request, is a request received by a skilled nursing facility (SNF) from a medical review contractor. The purpose of the request is to verify that claim payments to the SNF are for services that meet the necessary coverage, coding, billing and medical necessity requirements of the insurance provider. This is proven through documentation submitted by the SNF, which can include patient assessments, progress notes, lab results or other medical record details.
Should a SNF fail to respond to an ADR or the documentation does not justify the service in question, the claim is at risk of being fully or partially denied. Once a claim is denied, an appeal must be initiated if the SNF believes the claim was wrongfully rejected. If ADR efforts are not managed carefully at the facility level, the administrative burden can quickly become overwhelming—potentially leaving large amounts of money on the table.
Common ADR Challenges for SNFs We Solve
Difficulty adhering to ADR deadlines
Weak documentation processes
Lack of staff education and training of ADR compliance
Management of multiple ADR requests
Understanding and presenting appeals
Our ADR Management & Support Services
Pre-Audit Readiness & Compliance Support
Scrambling at the final hour to compile an ADR response is a stressful situation for everyone involved, especially if you are days late in discovering the request. With an ADR checklist and designated roles and responsibilities, ADRs can be completed with ease. Richter can help your organization:
Establish an ADR readiness checklist
Assign a dedicated ADR response team
Identify specific roles, responsibilities and tasks of the ADR team
Develop comprehensive ADR policies and procedures
Employ protocols to ensure proper signatures and documentation are in place before Medicare and third-party payer billing
ADR Response & Submission Assistance
Knowing what to submit in an ADR is only half of the battle; understanding and locating the information needed before the deadline is a much bigger challenge. When you lean on Richter’s team of experts to oversee your ADR response, we will ensure you:
Establish a routine for monitoring new notification requests
Understand the request notice and information required
Receive a documentation review by one of our highly-trained clinicians
Compile an organized and complete submission
Utilize an appropriate ADR tracking management system
Denial Management & Appeals Support
A SNF may experience a claim denial due to insufficient documentation, failure to support medical necessity, incorrect coding, or various other reasons. The facility has the right to appeal the decision, but the best approach to denials management is to prevent them in the first place. With Richter as your qualified ADR partner, we can assist you with:
Medical recordkeeping training for SNFs
Identifying gaps in systems and processes to increase compliance
Corrective action plans to prevent future denials
Reopening requests for minor errors or omissions
Redetermination appeal requests
Ongoing Monitoring & Education
Every SNF wishes to minimize the volume of ADRs they receive—and any denials that may result. The best chance of accomplishing this is to effectively train your staff to ensure documentation in a patient’s medical record supports the claim. Keeping abreast of evolving payer documentation requirements, however, can make compliance an overwhelming challenge. Richter’s clinical consultants can provide:
Education on the financial impact of ADRs
Training and education on the PDPM (patient-driven payment model)
Quality Assurance and Performance Improvement (QAPI) initiatives
Triple-check internal audit processes to ensure billing accuracy
MDS and interdisciplinary team education for new hires or tenured staff
Why Choose Us for ADR Management?
An ADR can and should be expected by a SNF at any given time, and the request should always be taken seriously. By proactively aligning your people and processes, the ADR process becomes straightforward and the request can be completed well in advance of the deadline. Our clients hand-select us to manage their ADRs because we provide:
Diligent oversight of the ADR process from beginning to end
Relief of the administrative burden in compiling, submitting and tracking ADRs
Realistic solutions for streamlining your ADR processes
Best practices to maximize claim reimbursements
Clarity and familiarity with the guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) and your local Medicare Administrative Contractor (MAC)
To learn more about how Richter can provide ADR management and support services starting today, please fill out the form below to request more information or contact us here.
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