Additional Document Requests (ADRs) Hospice


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.


Would your documentation pass a Medicare audit? Does your documentation support the services you are billing to Medicare? With increasing regulatory requirements and scrutiny of documentation to ensure services billed to Medicare are reasonably and medically necessary and meet the statutory requirements it is imperative that providers understand the requirements and the documentation required to support Medicare coverage.

Come hear firsthand from your Medicare Administrative Contractor Provider Outreach and Education Consultant about how to strategize to survive a medical review audit. Shelly Dailey MSN, BSN, RN, CPHM has more than ten years of experience with Medicare documentation, and she will be providing firsthand knowledge about auditing processes, responding to a hospice ADR, and documentation requirements. During this session, we will examine the latest information and data that drives medical review audits, top medical review denials and how to avoid them, as well as the new hospice beneficiary election statement addendum. This session is designed to give providers the tools, and information to design and implement a strategy to be successful during a medical review audit.

Hospice Topics (objectives):
  • Gain an understanding of current auditing processes.
  • Identify top denial reasons for medically reviewed hospice Medicare claims.
  • Develop an understanding of how documentation plays a key role in supporting terminal prognosis.
  • Gain an understanding of the documentation requirements to support services billed for Hospice.
  • Understand the goal and purpose of the election statement addendum.


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.