ADR is a Medicare term, although other payers and insurance entities may use it too. It stands for
Additional Documentation Requested.
What that means is that there is something on the claim that is unclear, or unsupported and they want more information. This can be anything from clarification of coding, to documentation of diagonses. Whatever they need to have reviewed, they will send it back to you in an ADR, and you will have a specific amount of time to return the documentation. If not, your claim will be denied.
So make sure to check your correspondence file. Things left unread could cost your office money.
Until next time:
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Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.