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March 20, 2023

Submitting Proper Documentation in Response to Additional Documentation Requests (ADRs) for Hospice Claims

Tips for Responding to an ADR

Occasionally, a claim is selected for medical review and your Medicare Administrative Contractor (MAC), CGS, will request additional documentation from you to ensure payment is appropriate. If this happens, the medical review department at CGS will issue you an ADR with information it needs to continue processing the claim.

The information and tips below can help you provide a timely response, potentially avoiding claims denials.

Tips for Responding to an ADR

So how can you be sure to respond to ADRs on time, every time? Here are a few helpful tips.

  • Assign an ADR lead. Choose an administrative team member or nurse to lead this task, which should include watching for new ADRs, monitoring the status of existing ADRs, and ensuring documentation is submitted in a timely manner.
  • Check for ADRs. Work with the ADR lead to create an internal process to check on ADRs at least once a week. They can check myCGS or Fiscal Intermediary Standard System (FISS) Option 12 Claim Inquiry.
  • Note the due date. Mark down the due date listed in the ADR, or use this calculator to ensure CGS receives your response on time. ADRs are due within 45 calendar days of the request.
  • Double-check the documentation. Ensure that documentation is correct for the patient and claim by attaching a copy of the ADR letter (or FISS Page 07) as the first page.
  • Organize documents if you are submitting more than one ADR. For multiple medical review ADR requests, clearly separate the documentation for each claim.

What You Need to Respond to an ADR

To respond to an ADR, you'll need to share things like physician's office and hospital records, admission records, plans of care, and other medical records. Visit CGS's website for a full list of required items and a helpful documentation checklist to help you make sure nothing is missing.

View documentation checklist

If you have questions about the ADR process, please call the CGS Provider Contact Center at 1-877-299-4500, Option 1.

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