Medicare ADRs and Appeals
We have a 96% success rate assisting many Home Health and Hospice agencies with Medicare, Medicaid, and third party payor audits on behalf of healthcare entities and providers nationwide.
We assist providers with Additional Development Request (ADR) in various ways. We specialize in "full service" handling of all levels of the appeals submissions, to assisting with the drafting of templates, position papers and case summaries for healthcare providers who want to handle the appeals on their own. We provide education to identify and mitigate risk exposure avoiding Medicare ADRs and Appeals.
We form long-term relationships with our clients by using an approach that combines periods of intensive work with ongoing expert guidance and education.
ADR & Appeals consultations may include:
- Analyzing census statistics to determine key indicators, case mix and identify potential risk areas which may trigger an ADR Audit
- Reviewing clinical records to determine whether:
- Administrative requirements are met
- There are any documentation-related opportunities for improvement
- Key documentation requirements are compliant with corresponding benefit policies
- Writing independent expert cover letters summarizing patient eligibility, or drafting summary cover letters for staff to review and submit with the ADR or appeal
- Evaluating internal systems and processes to ensure that they support proper billing
- Provide an ADR tracking system
- Expert recommendations to mitigate future risks
- Assisting with the appeals process, including preparation and involvement with expert testimonial evidence before Administrative Law Judges
- Presenting expert witness testimony
- Developing and facilitating customized education in responses to identified issues
Our primary goal with every consultation is to identify and reduce or eliminate risk exposure.
Engaging our team of Medicare ADR Consultants will result in:
- We roll-up our sleeves and work side-by-side with you for your success
- Assuring the validity of your Home Health and Hospice agencies documentation tools and forms
- Ensuring that systems and processes identify billing-related issues prior to releasing claims
- Enhancing competence with regard to discerning and documenting Home Health and Hospice eligibility.
- Increasing the likelihood of successful payment of ADRs and appeals