Regulatory Articles

Ten Tips for Dealing with ADRs and Probe Edits

The Centers for Medicare & Medicaid Services (CMS) and its contractors have broad abilities to perform prepayment and post-payment medical reviews of hospice claims. Hospices most commonly find themselves dealing with prepayment medical reviews through the Additional Document Request or Additional Development Request (ADR) process initiated by their fiscal intermediary. Typically, these ADRs relate to a particular probe or edit conducted by the intermediary. The probe or edit may be service-specific (e.g. noncancer length of stay, general inpatient care, etc.), provider-specific or beneficiary-specific.

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