tci Part B Insider - 2017 Issue 11

Part B Billing: Review ADRs and Correct Problems ... or Else, CMS Warns

New Targeted Probe and Educate revamp punishes wrongdoers. If you've been lax in your response to your MAC's Additional Development Requests, you might want to rethink that. A new change request from CMS suggests that ignoring those inquiries may land your practice in hot water. Framework: In a transmittal issued in August, 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 been including ADRs in their provider error rates up to now. The...

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