Medicare Compliance & Reimbursement
Check Your ADR Knowledge on These Critical Questions
Hint: Know there’s more than one way to submit documentation. The Medicare carriers were slow to add topics to their Targeted Probe and Educate (TPE) claims review lists after a reprieve during the height of the pandemic. But a quick check on most MACs websites show that they are ramping things up — and you might want to revisit your TPE policies. Reminder: In March 2020, the Centers for Medicare & Medicaid Services (CMS) paused its TPE program operated by the Medicare Administrative Contractors (MACs) due to COVID-19. CMS opted to continue the pause until it announced last August that it was resuming TPE reviews — despite the COVID-19 PHE that was and is still in progress. CMS implied in its original messaging that it was instructing MACs to allow providers extra time to compile their notes when they received additional documentation requests (ADRs) for TPE reviews (see Medicare Compliance & Reimbursement, Vol. 47, No. 17). But that doesn’t mean you still don’t need to know how to submit ADRs, where to send information, and how long the timeline is for returning data to your MAC. Test yourself with these five questions on ADRs. 1. If you receive an ADR from your MAC during a TPE review, how many days do you have to respond to the request? 2. The TPE burden can be heavy for providers under review. On average, during each round the MACs usually require how many responses to ADR requests? 3. Once your MAC receives your documentation, how many days does it have to complete the medical review of your claims, according to CMS guidance? 4. Name a way that you can respond to ADR requests and return documentation to your MAC. 5. To expedite the ADR process, what should you include in your documentation cover sheet? Answers: 1) C 2) B 3) C 4) D 5) B
Medicare Compliance & Reimbursement
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