ADRs & Appeals
Weatherbee assists hospices with Additional Development Request (ADR) submissions, appeals, and education to identify and mitigate risk exposure.
ADR & Appeals consultations may include:
- Analyzing census statistics to determine case mix and identify potential risk areas
- Evaluating forms to ensure that they are technically valid
- Reviewing clinical records to determine whether:
- Administrative requirements are met
- Physician and interdisciplinary documentation demonstrates medical necessity and eligibility for care, including higher levels of care
- There are any documentation-related opportunities for improvement
- Writing independent expert cover letters summarizing patient eligibility, or drafting summary cover letters for staff to review and submit with the ADR or appeal
- Evaluating internal systems and processes to ensure that they support proper billing
- Developing an ADR tracking system
- Presenting recommendations to mitigate future risks
- Assisting with the appeals process, including preparation for testifying before Administrative Law Judges
- Providing expert witness testimony
- Developing and facilitating customized education in responses to identified issues
The primary goal of every Weatherbee consultation is to identify and reduce or eliminate risk exposure.
Engaging Weatherbee will result in:
- Assuring the validity of your hospice's documentation tools and forms;
- Increasing the likelihood of successful payment of ADRs and appeals;
- Ensuring that systems and processes identify billing-related issues prior to releasing claims; and,
- Enhancing interdisciplinary competence with regard to discerning, documenting, and defending hospice eligibility.
Please contact Weatherbee for additional information regarding how we can help you with ADRs and the appeals process.