Q&A: Strategies for managing ADRs

Q: Are there any best practices for managing additional documentation requests (ADR)?

A: One of the most important processes to establish is the flow of audit requests, from the point of entry into the organization to the close of each request. Because individual requests can have different outcomes or be in different stages of resolution, a tracking database is essential to manage such a large and complex process. Most requests have deadlines for submission of records, and denials also have time frames for appealing. Without an efficient way to manage multiple requests arriving at various locations in your organization, you will find request and response letters languishing on various desks (the chief executive officer is a common culprit). As a result, you could miss important deadlines and lose reimbursement you might be otherwise entitled to obtain.

Everyone involved must understand that record requests have to be prioritized—only patient care requests take precedence. Your committee should flow chart the path of common requests and identify the most efficient way of managing them. As keeper of the records being requested (although some audits will also request bills), consider the HIM department as the primary entry point for all requests.

Usually, the organization has 30 to 60 days to respond to an ADR, but this author has seen requests for records with a 15-day turnaround. With time needed for mailing and transitioning through mail rooms on both sides, the allotted time frame can be exhausted quickly. Email can be used (if encrypted), but what if the recipient is on vacation or leave? Have a backup plan or distribution list in place. Some requestors may have electronic portals for uploading. Check with your IT security officer before using these methods to send medical records.

An example of the progression of a request for records may go something like this:

1. Request letter received and date-stamped
2. Requests entered into the database (HIM alerted if not the receiving department)
3. Medical records retrieved by HIM; data information entered into the database (don’t forget to
4. charge for the records if permitted)
5. Records sent by HIM via express mail with return receipt requested (encrypted transmission may
6. also be permitted for some requestors)
7. Denial notification received and entered into database (enter “no findings” responses as well)
8. Appropriate department (case management, coding, billing office) notified
9. Denial reviewed, decision to appeal or agree made, and action entered into the database
10. Appeals handled in same manner, entering information into the database until closed

Note: For more information, see The Contemporary Guide to Health Information Management.