UNIQUE SITUATION: PCR/ADR

ilagtapon@kabafusion.com

So the person in charged of our PCR thought that a patient was a LUPA and he entered NA when doing the PCR however he made an error and there were actually 5 visits and so an ADR was sent to us. This staff is working on all the documents needed to submit for PCR and we usually have approval for first time submission. My question is: since he made a mistake of putting an NA and if this PCR will be approved or affirmed after submission, do we still have to go through the process of ADR and submit those since the reason we got the ADR is because of the PCR that was marked NA? We are confident that when he will submit the PCR for this patient it will be affirmed. Any input or link you can share will be helpful. Thank you!

Barbmacrn@gmail.com

My understanding is that once an episode hits an ADR, you must file an appeal and provide your evidence/rationale for why you believe all visits should be paid. You can explain your technical error but you need to proceed with the appeal process. I would make sure all 5 visits were skilled, reasonable, and necessary. Barb

ahcokc@ATT.NET

That is not the reason, you got the ADR due to new Medicare rule that was effective January 2017. All home health and hospice will be getting ADR forward, they will randomly pick patients. Just be sure to have all documentations ready.

ilagtapon@kabafusion.com

Thank you for your input. If you are talking about the ADR from Probe and Educate Review as a CMS project that started last year we were actually removed from their list as target and as per their letter we wont be receiving ADRs for next round as we were one of those 5% that passed their Probe and Educate Review. This letter that we received is telling us that the patient was not LUPA and documents should have been submitted for PCR but our staff enter NA so we are getting the ADR. I believed with the Probe and Educate Review it will be more than 1 chart that they will send for each agency.