Are your therapy and nursing teams calmly ready to respond to ADRs, or screaming in terror? Because ADRs can delay payment, affect cash flow, and bog down staff, your ability to fully understand what’s being requested and prepare a thorough response is imperative.
ADR Readiness – “We’re going to get ADRs, so let’s be prepared!”
What is the likelihood that your facility will get ADRs? (Hint: It’s the same likelihood that winter follows fall in Michigan.) Since you’re going to get ADRs, it’s imperative that your facility is ready! Here are some things to consider as you prepare for ADRs:
- As we mentioned in our previous post, your facility’s PEPPER will give you a strong indication of your risk level for ADRs. If you are an outlier, you’ll be targeted.
- Does your team understand the technical points that payers are seeking?
- Does your team also understand components in a complete medical record?
- Do you know how to prepare for payers’ most stringent requirements (CMS’ requirements might not be the most stringent by the way!), and apply those across the board?
- What are your processes for tracking different types documentation that will likely be requested?
- Are you already conducting multi-disciplinary triple check meetings?
ADR Response – “What happens when we get one?!”
Your facility received an ADR – now what? If you miss anything in your response, like a log or MDS code, you’ll be denied. Egad! Here are points for your team to consider as you respond to ADRs:
- ADRs are time sensitive! Alert the team, so everyone knows it came!
- What documentation and data should therapy gather?
- What is the best way for therapy, medical records, and nursing to collaborate?
- What comprehensive checklists do you have in place, so all information is gathered, reviewed by nursing/clinical experts, and checked for thoroughness?
- How will your team track all ADRs and monitor progress and outcomes across the board?
ADR Denials – “What do we do if it doesn’t pass?
You put all that thought and effort into your response to the ADR, submitted your reply on time, and still you were denied (insert sad horn sound here). Should you just give up? No way! Here are some considerations for ADR denials and appeals:
- What was the reason for the denial? Was it valid? If not, then prepare to appeal!
- How can you present a better case?
- What documentation should you provide this time?
- What types of teamwork does the appeal process require?
- What is the risk to your business financials – including potential payback liabilities and constraints on cash flow?
- How can you efficiently track appeals and watch them move through process (until they are paid!)?
The experts at Therapy Management, Inc. have created a systematic process for fastidiously responding to ADRs and getting claims approved. We help our SNF clients to understand the levels of appeal (which are different for managed care vs Medicare), as well as understand the technical requirements and how to prevent human error – e.g. minutes on UB must match minutes on MDS grids. Because we are experienced at compiling high quality documentation to support services provided, we have a 95+% success rate with clients with a high volume of ADRs.
If you need a therapy partner who is ready to help you win the ADR battle, talk with us! Call us at 248-349-9595 or email carrie@therapy-management.com
