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Welcome to Monday Minute with Melinda! This week’s video clip will provide some key elements of responding to Hospice ADRs.

We are here today to discuss a situation in hospice that has become very prevalent. Back in August of 2020, CMS restarted post payment reviews, while programs like Targeted Probe and Educate, that were pulling ADRs as you billed the claims, was put on hold and continues to be on hold. Post payment reviews have come to the forefront and are a huge issue. We have seen UPIC audits, SMRC audits, and the Medicare MAC issuing post payment ADRs. Sometimes it’s only one or two and other times it’s a lot. I want you to be aware that this is happening across the nation, not just in hospice, but home health as well. I want to point out a few key components for hospice’s when responding to those ADRs. One of the key elements that we see hospices struggle with when it comes to ADRs is that a particular calendar month’s claim is selected for ADR review. This most often occurs when it’s from the Medicare MAC and the hospice responds to that ADR review, they don’t include all of the required information. Any benefit period that has to do with that monthly claim, you must send the certification information, the face-to-face if it is applicable, etc. with that ADR review.

In other words, if you have a March claim that’s pulled for ADR review, and the benefit period for that March claim began back in February (technically January), and you have another one, or January and you have another one that’s beginning in the month of March, you’re going to need to send the certification information from both benefit periods with that monthly claim information. Make sure that you have someone clinically review that ADR chart before you send in for review and make sure that it’s assembled appropriately. Our preference is that you include a cover letter. Once that ADR chart has been assembled and appropriately compiled and reviewed, please make sure that you are diligent about being timely. If it tells you that it’s due in 30 days, it’s due in 30 days. That doesn’t mean you put it in the post office on the 30th day.

Make sure that you are submitting them timely, have someone clinically review them, use the checklist that they have given you, and provide a cover letter to explain that patient’s care or recap (I should say) that patient’s care and point them (auditors) to certain places within the chart to give them the information they immediately need at their fingertips to be able to review that chart effectively.

Thank you for listening today. We hope that you will not need this minute anytime soon. But if you do, hopefully it has been helpful. Feel free to give us a call or send us an email if you have any additional questions. Also, make sure to check with your state homecare associations for assistance or additional education that they might be providing. Thanks again and I hope you have a great week.

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