Harmony Healthcare Medicare Newsletter
Reimbursement and Compliance Consultants
for the Long Term Care Industry
MEDICARE, MEDICAID, MDS 3.0, COMPLIANCE, PPS RUGs III,
THERAPY OPERATIONS and More.
Circulation: More than 17,000 Long Term Care Professionals | |
| HARMONY UNIVERSITY |
|
MMQ, MDS, PPS; A United Front
9/29/09 - 10/1/09
AANAC RAC-CT Cert Program
with Rena Shephard
10/14/09
Restorative Nursing
|
|
Look for us at the following Conventions:
New England Alliance of ACHCA
CEO Kris Mastrangelo is presenting on RAC Audits
Portland, ME
ANHA
Birmingham, AL
September 22, 2009
AHCA-NCAL
Chicago, IL
October 4-7, 2009 |
AASHA
Chicago, IL
November 8-11 |
|
Thrive in this Economy with
Medicare and Medicaid Reimbursement
|
|
Prevent Denials
ID Non-Compliant Charting
Identify BEST Care Strategies
|
|
Join Our List
|
 |
|
|
|
Notes from the desk of our CEO Kris Mastrangelo |
|
Additional Development Requests
When a Medicare contractor (MAC) cannot make a coverage or coding determination from the information that has been provided on a claim and its attachments, then the facility may be asked for additional documentation and receive an Additional Development Request (ADR). The MAC requests records related to the claim(s) being reviewed, and may collect documentation related to the patient's condition before and after a service in order to get a more complete picture of the patient's clinical condition.
Each MAC should have a location on their site addressing ADRs to assist providers with this process. Please note that this process does not include requests generated by Recovery Audit Contractors (RAC), Quality Improvement Organizations (QIO), Comprehensive Error Rate Testing (CERT), and non-medicals such as National Provider Identifier (NPI) issues.
The Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) functions allow all providers to view ADRs online. If you are set up to submit claim attachments electronically, you must use the online system to identify claims and view the ADRs. When an ADR is generated in the system, most MACs will not send a hardcopy ADRs for claims pending. It is imperative that the business office routinely search for ADRs and notify the necessary team members in the building.
Documentation must be as complete as possible to allow medical reviewers to determine the appropriateness of the billed services. Providers should gather all requested information and submit the medical records by the due date on the ADR.
If all information requested in the ADR is not submitted, the claim could be denied. Submitting complete documentation will help decrease the number of denials because the "documentation needed to make a determination is missing," and will help decrease the number of appeals which are a result of incomplete documentation. If no documentation is received within 45 days of the ADR date, then the system will deny the claim. To determine what documentation is necessary, utilize the Local Coverage Determination/National Coverage Determination databases. Claims will be reviewed and processed based on the documentation submitted in response to an ADR.
Providers who do not respond in a timely manner will continue to have a high denial rate, and will be candidates for increased or continued medical review.
To read the full version of the NHIC "ADR job aide" and/or for more information on denials management, email or call the Harmony Healthcare Corporate Offices (978-887-8919).
Contact us and hear about our Mock RAC Reviews.
Check out our FALL Seminar Schedule
|
|
HARMONY UNIVERSITY
OT, PT, ST, Nsg and Adm. CEUs for ALL Programs!
For a Complete Seminar Listing:
www.harmony-healthcare.com |
|
FALL PROGRAMS
9/23/09
MMQ, MDS, PPS: A United Front
9/29/09 - 10/1/09
AANAC MDS RAC-CT Certification Program with Rena Shephard
10/14/09
Restorative Nursing
For a complete copy of the 2009 Harmony University Calendar or to register:
Contact Sue Pellegrini
1-800-530-4413, Ext. 21 | |
| Harmony's Career Center
Harmony Matches Employers with Employees.
|
Administator Available:
Northern Maine
MDSCs Available:
Albany, NY
Open Positions
Harmony is now accepting resumes for OT, PT and ST Professionals to Join our Team. Send your resume to:
MDS Coordinator
Chattanooga, TN
Rochester, NY
Administator
Roanoke, VA
North of Boston, MA
Rehab Professionals
Albany, NY
SNF OT
Mason, OH
Okeechobee Area, Florida
Eagle Lake, ME
Sarasota, FL
COTA: Meredith, NH
SNF PT
Damariscotta, ME
Rochester, NY
Mason, OH
Okeechobee Area, FL
Eagle Lake, ME
PTA: Meredith, NH
Throughout South Eastern MA
|
Sincerely,
Elisa Bovee
Director of Education and Training
Harmony Healthcare
1-800-530-4413 x20 | |
|
|
