Q&A: Monitoring additional documentation requests

Q: Do we need to monitor Medicare's additional documentation requests (ADR) as part of our denials management program?

A: ADRs should be reviewed carefully, as they are typically precursors to more formal audit requests from the Recovery Audit Contractors (RAC), Zone Program Integrity Contractors, Unified Program Integrity Contractors, and other government audit contractors. The data you track for government audit contractors is invaluable to you for your commercial payers. The problems encountered with your Medicare patients may also occur with commercial patients.

Additionally, as most in the industry predicted, commercial payers are using RAC data to perform their own audits. In fact, many of the third-party firms performing audits for the commercial payers are or were RAC auditors. For example,  the RAC for Region D is also the exclusive national Medicaid and Children’s Health Insurance Program payment error rate measurement review contractor, in addition to providing audit and recovery services for many large payer organizations.

Editor’s note: This article originally appeared in Revenue Cycle Advisor. For more information, see The Essential Guide to Healthcare Payer Contracting. To learn more about CDI’s role in denials management and appeals, click here.