Additional Documentation Requests (ADRs)
It is imperative that you utilize preventative and review strategies that will minimize your risk of denials. Consequently, you could decrease your chances of more ADRs in the future. CMS may increase scrutiny of providers with denial rates higher than the peer norm. You want to avoid this scrutiny!
Common causes for denial are:
- The estimate for how much longer skilled services are required upon recertification is missing, incomplete or invalid.
- Certification is present, but documentation is missing physician's plan of care.
- Requested documentation is not received timely.
- The initial certification was missing, incomplete or invalid, therefore the recertification episode is denied.
- The physician certification was invalid since the required face-to-face encounter was missing, incomplete or untimely.
- The notice of election is invalid because it doesn't meet statutory and/or regulatory requirements.
- Face to Face encounter requirements were not met.
- The physician narrative statement is not valid or present.
- The hospice plan of care does not meet the regulatory requirements according to the Conditions of Participation.
- Documentation does not support a terminal diagnosis.
HealthCare ConsultLink's team of seasoned professionals are experts at Home Health and Hospice documentation. We are able to identify the essential documentation needed for ADR appeals. We not only assist our agencies with their current ADR needs but are able to provide assistance with process development and education to promote compliant clinical documentation in the future.
Please call Healthcare ConsultLink at 888-258-1894 for your ADR needs!