CMS clarifies the ways physician practices can respond to additional documentation requests

October 25th, 2013 - Scott Kraft
Categories:   Audits/Auditing   Compliance  
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It’s one of the inevitabilities of running a physician practices that never happens at a good time and seems to rarely go very smoothly. You see an additional documentation request – known as an ADR – from either your Medicare Administrative Contractor (MAC) or one of Medicare’s ever-growing army of auditors.

A new CMS transmittal clarifies the way in which an auditor is to tell you how to respond to an ADR and the options you have for how to transmit the information. The change is effective Oct. 21. The transmittal applies to MACs, as well as these Medicare claims auditors:
* Recovery Audit Contractors (RACs), contract auditors who get a percentage of any money recovered for the Medicare program.
* Zone Program Integrity Contractors (ZPICs), responsible for uncovering billing improprieties that could be indicative of fraud.
* Comprehensive Error Rate Testing (CERT), a program that reviews a sampling of claims to determine an overall error rate for different provider and service types.

When you get an ADR, the requesting entity is supposed to tell you the acceptable methods to transmit the information from the practice to the auditor. They are supposed to accept this documentation via paper sent through the mail, fax, CD/DVD or electronic submission of medical documentation (esMD).

When using paper, the requesting entity is supposed to make clear that you can send in documentation via the U.S. Postal Service, FedEx, UPS or certified mail. The entity should provide a physical mailing address, not a P.O. Box. Typically, only the U.S. Postal Service can deliver to P.O. Boxes.

When documents are sent by fax, the requesting entity is encouraged to send a confirmation to the practice that the fax has been received.

MACs and the CERT are supposed to inform your practice that imaged documentation can be sent by any means. RACs and ZPICs should give you a phone number or Web site with instructions for how to respond by CD or DVD.

As for esMD, it’s a system intended to allow for the electronic conveyance, securely, of documentation from your practice to the requesting entity. More details are available at MACs and the CERT are encouraged to share information in ADRs about how to use esMD.


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