To many, the multiple contractor requests that comprise the world of medical review are simply summarized as “ADRs” – for accuracy, it’s important to identify and understand the components. A summary of impactful requests follows.
- Targeted Probe and Educate (TPE) Program
- CERT Program (Comprehensive Error Rate Testing)
- Supplemental Medical Review Contractor (SMRC), currently held by Noridian
- Current SMRC projects, updated 1/26/23:
- 01-056, SNF 3 Day Stay Waiver PHE
- 01-066, Schizophrenia in SNFs
- 01-088, SNF PDPM
- Current SMRC projects, updated 1/26/23:
- Recovery Audit Program
Proactive Steps to Ensure Requests are Received
- Verify the Provider Address on File. Validation of the provider address on file is essential to receipt of medical review correspondence routed via mail. Additional Development Request (ADR) letters are distributed to request medical records for review. At times, the provider address is no longer current, and the ADR letters are returned as undeliverable. Visit https://www.cms.gov/medicare/provider-enrollment-and-certification/manage-your-enrollment for guidance.
- Monitor the FISS/DDE system for any pre-payment requests to ensure timely identification of requests and optimize response time
- Review individual facility medical review processes to ensure compliance with contractor expectations
