Transmittal 567, Change Request 8563 dated February 4, 2015, stated that the Centers for Medicare and Medicaid Services (CMS) issued , has tightened the timeline for Medicare providers and suppliers to respond to Medicare Administrative Contractor (MAC) and Zone Program Integrity Contractor (ZPIC) requests for Additional Documentation Requests (ADRs).
Providers and suppliers are now limited to a 45 calendar day timeframe to produce the additional requested documentation. They should no longer expect that a request for an extension of time will be granted.
Pursuant to the Social Security Act, Section 1833(e) CMS contractors have the right to request additional documentation from the provider or supplier through an ADR and can withhold payment until the request has been complied with .
Furthermore Pub 100-08, Medicare Program Integrity Manual Chapter 3, allow them to notify providers that the requested documentation is to be submitted within 45 calendar days of the request.
It goes to say that extensions will not be granted and that claims will be denied if documents are not received by the 46th day.
If you have any questions, please feel free to give us a call today. We would be more than happy to assist you in these as well as other compliance-related matters.
Mr. Laher is an attorney in private practice with Liles Parker, PLLC. We counsel and defend Health Care Providers nationwide on Health Law related issues such as Medicare Audits & Fraud Defense, Medicare Prepayment and Over Payment issues, CMS Suspension and Revocation Actions, Practice Specific Gap Analysis, Compliance Plans, Hippa & Osha mandatory training, and with General Counsel and Compliance Officer Services.