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The ADR to Appeal Primer Part I and II

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PART 1 -

  • Why reviews are occurring
  • Who is doing review
  • Differences between reviewers OIG "red flags" for review
  • Types of reviews: ADRs, probes, audits
  • Current CMS focus: Targeted Probe & Educate
  • ADR requests from MAC/ZPIC/UPIC/RAC/CERT
  • Responding to an ADR Probes and Results

PART II -

  • Current denial trends
  • Reading a denial
  • Targeted Medical Review Appeals (Level 1 and Level 2)
  • ALJ hearing preparation, attendance
  • Financial concerns: extrapolation, recoupment
  • Compliant charting Face to Face requirements
Pre-recorded with Joe Osentoski, RN October 2017