If a facility does not respond to an Additional Development Request (ADR), can they appeal the denial?
A. Yes, they can appeal. The facility needs to understand, though, that the Appeals Deparment must review every line denied on the claim pertaining to the appeal before the denial can be overturned. Since the entire claim was denied for non-receipt of medical records, every line on the claim is subject to review, not just the line item(s) pertaining to the Medical Review edit. Therefore, if ALL documentation pertaining to the entire claim is not submitted for the appeals review, lines will still be denied for lack of documentation, and the entire claim will not be paid. Returning only the documentation requested on the initial ADR is not sufficient.
