Caryn Adams

I am seeing an increase in Medicare Replacement Policy additional document requests.  How should we respond?

First and foremost, make sure that the facility responds. Ensure that whoever receives the request understands what it is. ADR response is significantly different from a records release for a family or attorney.

The facility should have a policy and procedure in place as how to respond to ADRs. Medical records can pull the information, but I recommend it be reviewed by the MDS nurse and business office manager. 

Review the list sent by the requesting agency to make sure all requested items are included.  Be sure to look at the time frame being reviewed. You do not want to send them any more information than is necessary. Organize the information in an order that makes sense. 

Usually the request letter is the first page. Follow up with an index, face sheet, diagnosis list and MDS. Documentation to support the MDS coding is also essential. This is where you need to review the lookback dates for the MDS and compare with the dates being reviewed.  If the month of August is under review, but the ARD of the payment MDS is July 11, you will need to send documentation for August, but also include documentation during the lookback period of July 5- 11.

Review documentation for accuracy and completeness. Do not backdate, alter or add new documentation. 

Make an exact copy of what is being sent in and number every page. This will help you to refer to a document that the auditor conveniently does not find. It will also assist you should you need to file an appeal. Technical denials are not appealable. Also, be sure to read the appeal process for the specific company denying.