Additional Document Requests (ADRs) Home Health


The workshop will begin with a general overview of Additional Document Requests (ADRs) by expert faculty Annette Lee, who worked for over a decade with a MAC in medical review and education. This session will review the different types of audits and the processes followed by Medical Review, CERT, and RACs. Attendees will gain a better understanding of the medical review process, Medicare’s Additional Development Request, and Progressive Correction Action processes. Additionally, Ms. Lee will discuss the appeals process and documentation that would support the medical necessity for both home health and hospice.

Program Topics:
  • Gain an understanding of the targeted probe and educate (TPE) process.
  • Identify top denial reasons for medically reviewed claims.
  • Gain an understanding of the documentation requirements to support services billed.
  • Identify top denial reasons for claims.
  • Review Up to Date References and Resources for 2021 Regulations.


Shelly Dailey MSN, BSN, RN, CPHM, Provider Outreach and Education Consultant will be reviewing tips on responding to an ADR, the top medical review denials, and tips on avoiding those denials. This session will also cover Documentation of all five eligibility requirements to include the Face-to-Face Encounter, the Plan of Care, Homebound Status and the Need for Skilled Services. The permanent changes to the physician and non-physician practitioner (NPP) roles in Medicare home health will also be discussed in detail.

Home Health Topics (objectives):
  • Discuss current home health auditing processes.
  • Identify top denial reasons for Home Health Medicare claims.
  • Develop an understanding of the permanent changes to the role of the physician and NPP in home health.
  • Overview of all five certification requirements.
  • Up to date references and Resources for 2020 Medicare Home Health Regulations.


Annette Lee
RN, MS, COS-C, Cahaba GBA, and CGS
Provider Insights, Inc.

Annette is a registered nurse, with a Master’s in Health Care Administration, practicing since 1990, with the majority of her nursing experience in home health. For over a decade she worked with the CMS intermediary where she provided review of, and education on home health documentation. Annette then began providing outreach and provider education regarding Medicare reimbursement issues and effective documentation strategies, assisting providers with ADRs and appeals. Today she marries together her experience in the “real world” and the inside knowledge of Medicare to ensure providers can meet the requirements of CMS, and ensure compliant, efficient operations. She presents nationally on OASIS, PPS, documentation and coverage and provides content expertise to the CMS OASIS Q&A Mailbox. Annette holds both the Certificate for OASIS Specialist-Clinical and the Home Care Coding Specialist-Diagnosis certification. She is an AHIMA approved ICD-10-CM Coding Trainer.


Shelly R. Dailey
Home Health and Hospice Clinical Consultant
National Government Services

A passionate patient and provider advocate with a Master’s Degree in Nursing, Shelly has 25+ years of experience in health care; including an Associate Degree and certification in Healthcare Administration. Shelly became an integral member of the NGS Mobile Medical Review Team in 2011 and joined Provider Outreach & Education at NGS in 2014. She has a significant background in state and federal Medicare regulations, nursing education, home health, hospice, adult medicine, psychiatry, skilled nursing facility, ambulance, and inpatient and outpatient hospitalization. Shelly is also an adjunct professor at Roberts Wesleyan College in Rochester, NY and a matriculated Ph.D. student at The Catholic University of America in Washington, D.C. She has worked closely with the Departments of Justice, Health & Human Services, the FBI and the OIG on multiple Medicare fraud trials, and has received two prestigious NGS awards, Continuous Improvement and Values in Action, for her hard work and dedication to provider collaboration and education. She is a Member of the CNY Medical Reserve Corp, the American Nurses Association, the New York State Nurses Association, the Sigma Theta Tau International Honor Society of Nursing and the International Nurses Association (INA), who recognized Shelly as a World-Wide Leader in Healthcare in 2017.


Cancellations are subject to 20% handling fee. There will be NO REFUNDS issued for cancellations received within 10 business days prior to program. Cancellations must be in writing. Refunds will not be made for no-shows. However, substitutions will be allowed. Should CAHSAH® cancel the program, a full registration fee refund will be issued.


Provider approved by the California Board of Registered Nursing (Provider #CEP17394) for five and one half (5.5) contact hours of continuing education. You must be present for the entire workshop to earn Continuing Education Units.
No partial credits can be given.
Certificates are distributed at the close of the program.