The biggest part of ADR denials are non-responses! Is your agency part of this problem? Put some safeguards in place so you aren’t denied because of a non-response.
- Make it part of someone’s job to check the FISS daily to see if claims are being ADR’d before the hard copy comes in the mail – some MACs have done away with mailed copies
- Furnish a timely response with all the information requested, even if some of the information is from a previous episode and include a cover letter which summarizes the patient information and the reason for the ADR.
- Make a log to keep track of the ADR and follow up when necessary.
- Use the ADR as a learning tool – educate your staff about why the claim was ADR’d and what steps to put into place so it doesn’t happen again