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Home Health & Hospice Week

Hospice:

Here's Your Best Bet For Managing Additional Development Requests

Published on Tue Aug 25, 2009

Use this expert advice to beat claim denials and worse. Mastering ADRs can move your hospice to the head of the class in preventing payment denials and compliance woes. Start by being aware of the different types of medical review. Hospices do see some "plain vanilla" ADRs from the MACs or FIs that aren't part of a probe, says attorney Mary Michal, with Reinhart Boerner Van Deuren in Madison, Wis. For the most part, however, hospices are involved with ADRs due to a probe edit or a beneficiary edit. As for the latter, "denied claims will often result in each succeeding claim being subject to an ADR for the same patient" until they get turned over, which is one reason to appeal in a sophisticated way, says Michal who presented on ADRs in an audioconference sponsored by Eli Healthcare. If the hospice is on a probe edit, the FI or [...]
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