Episode 393 - Medicare Advantage and Your Obligation to Comply - #TerryTuesday

Summary

In this episode, Sean M Weiss and Terry Fletcher discuss the complexities surrounding Additional Documentation Requests (ADRs) from Medicare Advantage plans. They emphasize the importance of compliance, the legal obligations of providers, and the potential consequences of ignoring these requests. The conversation also touches on the ongoing investigations into Medicare Advantage fraud and the need for providers to navigate these challenges carefully while maintaining good relationships with payers.

Takeaways

• Responding to ADRs is a legal obligation for providers.
• Ignoring ADRs can lead to serious consequences.
• Providers should negotiate terms if requests are unreasonable.
• HIPAA allows disclosures for payment-related activities.
• Payers are permitted to request specific documentation for audits.
• Maintaining a good relationship with payers is crucial.
• Providers can ask for clarification on ADR requests.
• Documentation requests should be fulfilled within narrow parameters.
• The OIG investigates Medicare Advantage plans for fraud.
• Providers should utilize electronic means for submitting documentation.