Home Care Alliance members are reporting an increase in” additional documentation requests” or ADRs from the fiscal intermediary, NHIC. Although there does not seem to be a pattern to the diagnoses requested, the majority are LUPAs. Additionally, many are being denied after the initial review and the first appeal. Members are encouraged to continue the appeal process if you feel your decision has merit.
The fiscal intermediaries are required to do a certain percentage of review and it is usually around 10%. This is in addition to the TPL process which created a backlog until recently and is why they may be “catching up” to their regular workload.
Members are encouraged to contact Helen Siegel at firstname.lastname@example.org with appeal results and/or if the number of ADRs seems unusually large.