Additional Documentation Requests (ADRs) are on the rise and can be very costly to your homecare business. On January 12, 2012 our friends at Ohio Council for Home Care and Hospice clarified that a number of their members received ADRs, and Palmetto recently stated “there will be more in the near future as new edits have been recently placed on some of the reviews”.
The purpose of this post is not to be a guide to fix ADRs but a source of information and resources shared from the many conversations going on across the nation regarding ADRs.
Consistent throughout the information being shared by home health consultants and professional associations, is to implement a proactive ADR management strategy. While it is certainly important to have a plan in place to respond to ADRs, avoiding them altogether by putting a proactive strategy in place will have more significant long-term benefit to your agency. As they say, proactive is always better than reactive.
The 3 T’s of Proactive ADR Management
Success in home health is very dependent on human resources. We are in a people business which requires excellent talent in both the field and the office. Your staff needs the aptitude to learn and understand the importance of complete documentation and process as it relates to the health of your business and the continued ability to care for patients in their home.
Focused training on activities that can minimize ADRs include the Intake/Referral process, OASIS Assessment and clinical documentation, QA, Order Management, Coding, and Pre-Billing Audits.
Several technologies can help agencies implement and manage to a more proactive environment.
Agency Management Software - A comprehensive home health agency management software system helps agencies adhere to regulatory requirements by putting checks and processes in place up front in key processes. Key features to look for that can help minimize ADR impact includes:
Electronic Intake/Referral capabilities that requires certain data (such as Point of Origin) to be collected in the admission process.
Scheduling functionality that matches orders to schedules
Correct G-Code documentation at the Point of Care.
Order Management features that enable an agency to verify that an order is complete, signed, and dated prior to releasing an electronic trigger for that pre-billing check.
OASIS Inconsistency Checking that alerts agencies to changes between assessments prior to OASIS and claims submission.
Comprehensive Pre-billing Checks that hold claims from being created until necessary upstream processes are clean such as ensuring orders, schedules, and visit records are properly QA’d, validated, and complete.
OASIS Scrubbing - To compliment the process-driven agency management features, an additional layer of OASIS scrubbing can also be a significant element in your strategy. There are several available tools such as Home Health Gold, PPS Plus, and Strategic Healthcare Programs (SHP) that integrate with agency management software to provide additional OASIS analysis.
Point of Care - Adopt Point of Care documentation technologies that facilitate timely, accurate, and complete documentation. If your staff is not documenting at the point-of-care, then its not point-of-care. All too often in home health, clinical documentation is not completed at the point of care due to the complexities in many technology-heavy approaches. Thus, nurses end up documenting after the fact, which impacts downstream processes and also reduces accuracy, as the human brain continually loses information over time.
HomeSolutions.NET has been built to help agencies manage their business in a more proactive manner with several in-line processes and Flex Point of Care options. When combined with OASIS scrubbing tools, exceptional talent, and focused training, the impact of ADRs can be minimized significantly.
ADR Resources – Industry
We encourage providers to monitor the many ADR topics on their state and national homecare association listserves. Here is a list of other known resources. If you have more you’d like to share please contact us and we’ll continue to update this resource.
Michael McGowan – Medicare Appeals Development - http://www.madappeals.com/
Carol Anderson – Article regarding having a pre-billing audit plan
Haydel Consulting - Blog: http://haydelconsultingservices.com/2012/01/