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Home Health & Hospice Week

Industry Note:

Don't Waste Money Failing To Respond To ADRs

Published on Tue Aug 16, 2011

If you're receiving claim denials with reason code 56900, you're throwing your money away for no reason. That code indicates that "the medical records to support the services billed [were] not received timely," explains HHH MAC CGS in a new post on its website. In other words, you failed to respond to the Additional Development Request (CDR) within the required timeframe (30 days for submission, 45 days for CGS to receive and process). Receiving time-out denials "negatively impacts cash flow" and "creates the need to requestappeals, which can be costly and time consuming, in order to receive Medicare payment," CGS warns. And don't forget that "ADR denials are incorporated into overall denial statistics," CGS adds. Higher denial stats could lead to continued medical review of your claims, the MAC cautions. Do this: "We encourage providers to have a process in place to monitor the Fiscal Intermediary Standard System (FISS) status/location [...]
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