How to respond to ADRs, and how to appeal when necessary.   So you think your documentation is audit proof, but ADRs are coming in and RACs are knocking on your door – now what?

 

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Home Health ADR & Appeals Answers, First Edition, will walk you through how to respond to ADRs, and how to appeal when necessary. Gleaned from experience with thousands of ADRs and appeals and hundreds of ALJ hearings, home health reimbursement recovery & appeals expert Joe Osentoski shares his approach, which extensively integrates applicable Medicare rules and regulations to explain what is happening, what should be happening, and how to apply these in the Medicare review and appeal process.

This must have resource covers:

• The current state of home health compliance: Are reviews happening, to whom and how
• Who's looking at your charts? (MAC, ZPIC, UPIC, OIG, RAC, CERT, insurance/SCIO)
• The rules and regulations (Medicare Benefit Policy Manual, CFR, Local Coverage Determinations)
• Charting to the medical reviewer: clinical guidance related to denial reasons, and how these differ from a surveyor focus
• Keep your hard-earned reimbursement: financial implications, demand letters, overpayment, extrapolation
• ADRs: The start of the process from receipt, processing, reminders to differences between the MACs
• Appeals: Level 1/Redetermination and Level 2/Reconsideration
• Administrative Law Judge (ALJ) hearings: Level 3 appeal process, preparation, hearing attendance
• Beyond the ALJ, and Insurance appeals (Medicare Appeals Council, Medicare Advantage differences
• Bringing it all together: charting, response to review and denials, resources, reminders