Q&A: Monitoring additional documentation requests

December 3, 2018
Medicare Web

Q: Do we need to monitor Medicare's additional documentation requests (ADR) as part of our denials management program?

A: ADRs should be reviewed carefully, as they are typically precursors to more formal audit requests from the Recovery Auditors, Zone Program Integrity Contractors, Unified Program Integrity Contractors, and other government audit contractors. The data you track for government audit contractors is invaluable to you for your commercial payers. The problems encountered with your Medicare patients are also occurring with your commercial patients. Additionally, as most in the industry predicted, commercial payers are using RAC data to perform their own audits. In fact, many of the third-party firms performing audits for the commercial payers are or were RAC auditors. For example HDI, now owned by HMS, not only serves as the RAC for Region D but is also the exclusive national Medicaid and Children’s Health Insurance Program payment error rate measurement review contractor, in addition to providing audit and recovery services for many large payer organizations.

For more information, see The Essential Guide to Healthcare Payer Contracting.