Home Health & Hospice Week

Use MAC’s checklist to respond to ADRs.

Don’t forget that medical reviewers will be poring over your claims for face-to-face documentation — even for recertifications.

“Effective for dates of service on or after August 11, 2015, when a claim is selected for medical review, providers will be required to submit all certification documentation as well as recertification documentation,” HHH Medicare Administrative Contractor CGS says on its website. “CGS will review the initial certification and face-to-face documentation with every claim including a recertification.”

You may want to consider using the Centers for Medicare & Medicaid Services’ voluntary form for face-to-face physician encounters, issued last month (see Eli’s HCW, Vol. XXIV, No. 30). Despite its flaws, use of the form may prevent you from having to obtain your referring physicians’ medical records to fulfill the F2F requirement. You can access the form in a zip file link at www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10564.html.

For a checklist of items to respond to Additional Development Requests, in preferred order, see CGS’s medical review webpage at www.cgsmedicare.com/hhh/medreview/adr_process.html.