ADR Compliance & Pre-Bill Review Services are services provided by McBee to help healthcare providers ensure that all clinical documentation is present before billing, in response to additional document requests (ADRs) that come with initiatives like Targeted Probe and Educate (TPE). This helps prevent denials or payment delays by responding quickly to ADRs, crafting winning appeals for denied claims, and providing tailored solutions to optimize current processes and reduce future risk.

A pre-bill audit is a review of medical bills that occurs prior to submission to an insurance company. The purpose of this audit is to ensure that the medical bills are accurate, complete, and comply with the insurance company’s requirements. The pre-bill audit is performed by a third-party company (such as McBee) that specializes in medical billing and coding. This company will review the medical bills to identify any errors, discrepancies, or missing information.

A pre-bill audit is important because it helps to reduce the number of claim denials and delays in payment. Insurance companies have strict requirements for medical billing and coding, and any errors or discrepancies can result in a denied claim or delayed payment. By conducting a pre-bill audit, medical providers can ensure that their bills are accurate and complete, which can help to speed up the payment process and reduce the risk of denied claims.

There are several benefits to conducting a pre-bill audit. First, a pre-bill audit can help to identify any errors or discrepancies in medical bills, which can help to prevent claim denials and delays in payment. Second, a pre-bill audit can help to ensure that medical bills are in compliance with insurance company requirements, which can also help to prevent claim denials. Finally, a pre-bill audit can help to improve the overall revenue cycle for medical providers by reducing the number of denied claims and speeding up the payment process.

Any medical provider who bills insurance companies can benefit from a pre-bill audit. This includes hospitals and clinics, physician practices, home health care providers, hospice organizations, skilled nursing facilities, and organizations that offer behavioral health & human services. By conducting a pre-bill audit, medical providers can ensure that their bills are accurate, complete, and in compliance with insurance requirements. This can help to reduce the number of denied claims and speed up the payment process.

A pre-bill audit is performed by a third-party company that specializes in medical billing and coding. The company will review the medical bills to ensure that they are accurate, complete, and in compliance with insurance requirements. This review may include a review of medical records, coding, and billing information.

An Additional Documentation Request (ADR) is a request made by a Medicare Administrative Contractor (MAC) or Recovery Audit Contractor (RAC) for additional information to support a claim for payment.

The purpose of an ADR is to ensure that the services billed to Medicare are medically necessary, correctly coded, and appropriately documented in the medical record. ADRs help identify errors and potential fraud, waste, and abuse in the Medicare program.

If you receive an ADR, you must respond within the timeframe specified in the request. Failure to respond to an ADR can result in claim denials, payment recoupments, and/or referral to law enforcement for potential fraud.

You should submit all relevant documentation to support the billed services, including but not limited to medical records, laboratory results, imaging studies, and other relevant documentation. It is important to ensure that the documentation is legible, complete and supports the services billed.

Yes, you can appeal an ADR determination if you disagree with the decision. The appeals process may vary depending on the type of contractor that made the determination. It is important to review the specific appeals process outlined in the ADR determination letter and submit a timely and well-supported appeal.

McBee helps healthcare providers improve their billing compliance by identifying areas for improvement in response to specific ADRs and denied claims, educating staff on pre-bill best practices, and providing clinical feedback and recommendations to increase billing compliance and prevent continued denials. McBee also offers a proprietary software tool designed for ADR compliance, as well as, pre-bill audits to improve billing quality in response to Medicare-focused reviews.

Some related services offered by McBee include Revenue Cycle optimization, Denials & Appeals Management, Episode Management to improve visit utilization, increase reimbursement, and reduce readmissions, and Transfer DRG to recover Medicare underpayments and receive full reimbursement.

To learn more about McBee’s ADR Compliance & Pre-Bill Review Services, contact us, and our team will reach out with more information and answer any specific questions you may have.

The McBee Advantage is a multifaceted approach to ADR compliance and pre-bill review services. It includes a direct approach to helping providers develop a proactive review process and strategy, as well as well-crafted, winning appeals, and in-depth knowledge of healthcare regulations and policies. McBee’s clinical consulting group has more than 20 years of experience in the industry.