tci Medicare Compliance & Reimbursement - 2017 Issue 19

Compliance: Ignore ADRs and Pay the Consequences, CMS Warns

A prompt response is required under the Targeted Probe and Educate program. Before you shuffle that Additional Development Request from your Medicare Administrative Contractor to the bottom of your to-do pile, you might want to think again. A new change request from CMS suggests that ignoring those inquires may land your practice in hot water. Framework: In a transmittal issued last month, CMS directed the MACs to “include claims denied due to no response to Additional Development Requests (ADRs) when calculating the provider error rate” starting Sept. 19. The instruction in CR 10210 implies that MACs haven’t...

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