Oncology & Hematology Coding Alert

Question: I've been hearing a lot about CMS's Targeted Probe and Enforcement program since the fall, but I haven't really paid attention. What do I do if an ADR shows up?

Colorado subscriber

Answer: Pay attention to the communications from your Medicare Administrative Contractor (MAC), especially if you see anything about an Additional Development Request (ADR) and prepare the necessary information to respond to the request. The ADR will require sending the documents listed on the ADR and any related physician's orders or intent to order. You will also need to make sure the physician's signature is legible or include an attestation of signature.

Even experienced billers may not prioritize ADRs because they either don't know they should, or they don't know how.

"Newer agencies and those with poor management consider billing to be a data entry task and is not given the respect that it deserves," saysJulianne Haydelwith Haydel Consulting Services in Baton Rouge, Louisiana.

Billing itself may indeed be a data entry task. But "managing the process, following up on claims, verifying claims were paid at the amount they were billed is not merely data entry," Haydel argues.

Failing to allow enough time and resources for billing and related tasks is a problem, Haydel suggests. For example, "In small agencies, even when the biller has experience, he or she may be under pressure to get billing out so payroll isn't a problem if the biller took vacation or sick leave."

Billing staff may also be less likely to respond to ADRs if billing systems don't support it, Haydel adds.

"Some computer systems allow an agency to print a chart. [For] others, the process involves going in and printing off each note and order and care plan individually," she notes. "This is labor-intensive, and it doesn't take much to convince someone to defer the task until later - which never comes."