tci Medicare Compliance & Reimbursement - 2014 Issue 23

Industry Notes: CMS: Submit Requested Documentation within 45 Days,or Face Denials

If your payer is performing a pre-payment audit of your claims, the MAC will typically ask you for additional documentation. In the past, some MACs would say you had 30 days to submit the documentation, while other insurers might not have given you a timeframe at all. CMS has cleared the air on this topic, confirming that you have 45 days to respond to an Additional Documentation Request (ADR), the Centers for Medicare & Medicaid Services’ (CMS) says in MLN Matters article MM8583, issued on Nov. 14 and effective on April 1, 2015. On the 46th day after the...

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