ADR BASICS
What does ADR stand for?
What is Additional Documentation Request?
Which document must clearly show the resident’s skilled need on a day‑to‑day basis for an ADR review?
What are daily skilled nursing notes?
What does MDS stand for?
What is Minimum Data Set?
Which outcome occurs when all documentation is complete and supports skilled need?
What is "Fully Favorable"?
Which entity sends ADR letters to skilled nursing facilities?
Who is the Medicare Administrative Contractor (MAC)?
What is the top 1 denial reason in the region?
What is the Section GG?
What does HIPPS stand for?
What is What is Health Insurance Prospective Payment System?
If documentation is missing for case‑mix drivers, what outcome is likely?
What is HIPPS downcode?
How long do facilities typically have to respond to an ADR?
What is 45 days?
What document verifies physician oversight for Medicare Part A beneficiaries?
What is the physician certification/recertification?
What does a default HIPPS code of “ZZZZ” usually indicate?
What is incomplete, incorrect, or invalid MDS data?
What outcome occurs when documentation cannot justify skilled level of care?
What is claim denial?
What happens if an ADR packet is NOT submitted on time?
What is automatic claim denial?
Which therapy document is required to justify skilled rehabilitation services in an ADR?
What is the therapy evaluation?
Can a facility manually change the HIPPS code on an MDS?
What is no — it must be system‑generated?
What financial action is required when an ADR denial occurs for services older than 24 months?
What is write‑off?
How many levels of appeal are available in the Medicare ADR process?
What is "5"?
If nursing notes do not reflect skilled need, what ADR outcome is most likely?
What is claim denial?
Is it appropriate to modify an MDS after an ADR downcode when a factual coding error existed?
What is YES?
What major financial consequence can occur when a facility repeatedly submits incomplete ADR packets?
What is an increased likelihood of claim denials and loss of reimbursement?