This week, we have been notified that phase 2 and phase 3 providers are receiving ADRs for October claims for resident’s who were at or over the $3,700 threshold.  Phase 1 providers who have pre-approval are receiving ADRs as well.

If you are a Functional Pathways partner, please inform your therapy manager immediately of the ADR and provide a copy of the ADR to your therapy manager.  The therapy manager will collect and provide all necessary therapy documentation to you to submit for the ADR.

If you have approval for therapy visits and receive an ADR, please submit the approval letter along with the therapy documentation and service logs in the ADR packet.

According to CMS’ Q & A MMRP sheet:

Q: “If I am in Phase III, what happens to my claims during the timeframe of October 1, 2012 to November 30, 2012?”

A: “Phase III is scheduled to begin for services expected to be furnished on or after December 1, 2012. Claims for services furnished before this time will be treated in the same manner as claims for services below the $3,700 threshold.”

“Q: If I am in Phase III would a Medicare contractor conduct review of my claims from October 1, 2012 to November 30, 2012?”

A: “Medicare contractors have the authority to review any claim at any time.”

CMS_Implements_Manual_Medical_Review_Process_for_Outpatient_Therapy_Above_the_$3700_Threshold