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Team effort streamlines ADR process

Patient Financial Services Weekly Advisor, May 28, 2004

Over the past three years, Becky Cornett, PhD, CHC, has been hard at work on a piece of the puzzle at her health system: getting paid.

Cornett, director of compliance coordination at Ohio State University Health System in Columbus, spearheaded an initiative to ensure compliance with fiscal intermediaries' (FI) requirements for additional development requests (ADR).

An ADR is a notice sent from the FI when its medical-review department requires more information to consider and pay a Medicare claim.

Getting departments to change processes can be a challenge, Cornett says. "My mantra is, 'but we still don't have the money.' If we don't have the money, we need to show why. It doesn't matter if we think we did it right."

Cornett offers the following words of advice:

1. Don't wait for a crisis to happen. If your facility receives a letter from the FI that says you're not responding in time, or you're sending the wrong information, it will not only hold up the process, but threaten payment. You could appear suspicious or as though you're withholding information, with the perception that you're doing something wrong.

2. Write down everything. Cornett issued a three-page document to all parties explaining what information could be requested, how to get it, and what to do with it. More than that, she explained why ADRs are a problem and the impact they have on payment.

3. Talk to FIs-they can help. Adminastar provided Cornett's health system with a checklist addressing process tips and important aspects of clinical care and documentation.

4. Take the show on the road. After designating a team on the corporate level, which involved finance, compliance, medical records, and clinical staff, Cornett went to each unit in her health system (a cancer center, medical center, acute-care community hospital, and psychiatric hospital) to discuss the issue and solutions. Each facility had its own team leader who was held accountable for not only disseminating the information, but following up and monitoring each unit's progress. That leader reported to the corporate team.

5. Involve clinicians in review. A few years ago, clinicians never looked at ADRs. Now, for each unit, a clinician reviews each ADR before it goes out the door. "You want to tell them that they should get the money for what they did," she says. "That helps."

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