ADR and Appeals Management
In the past few years, the home health and hospice industry has experienced more scrutiny from regulatory and payer sources than in the history of the industry. This scrutiny has led to an increase in provider audits, whether through the traditional Medicare (Additional Documentation Request (ADR) process, the Targeted Probe and Educate Review (TPE) or through other pre-payment and recovery audits. BlackTree’s clinical consultants, experienced in the management of in-depth chart reviews and responses to appeals, are able to perform detailed documentation analyses and draft responses to support reimbursement of the care provided. During the BlackTree ADR and appeals management process, consultants will deliver recommendations for changes in practice, process, and methods of documentation in order to prevent or better defend future denials.
Initial ADR Review and Documentation Preparation
- Client submits the ADR request via a secured exchange server
- BlackTree performs a remote, comprehensive chart review focusing on Medicare documentation requirements, physician certification and eligibility requirements
- BlackTree provides a report outlining findings and recommendations for improvement for each record reviewed
- BlackTree creates an ADR cover letter for submission that includes supporting documentation, and location within medical record that draws attention to critical items for compliance