Medical Review Frequently Asked Questions (FAQs)

Q1. If my records are requested for review of outpatient therapy services, do I need to include the evaluation every time I submit records?
A1. Yes, one of the documentation requirements for outpatient therapy services is an evaluation and it is a requirement that the evaluation is submitted every time for the episode of care. Please refer to the Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220.3 for Documentation Requirements for Therapy Services. Additionally, Noridian does have a checklist for when submitting documentation for outpatient therapy reviews.

Q2. If I have questions or concerns about submitting documentation for review, what should I do?
A2. If you have questions on responding to a request for documentation, please refer to How to Respond to ADR on our Noridian Medicare website. Additionally, if you have concerns with submitting documentation within the 45-days for post pay reviews, we highly encourage you reach out to the manager of your case. Contact information for your case manager can be located in your notification letter.

Q3. What is the difference between activities of daily living (ADLs) and instrumental activities of daily living (IADLs)?
Activities of Daily Living (ADLs) are self-care tasks. ADLs include but are not limited to, dressing, feeding, toileting, grooming, physical ambulation and bathing. Instrumental Activities of Daily Living (IADLs) include tasks that a person does every day to take care of self and home. IADLs include but are not limited to, shopping, food preparation, using the telephone, housekeeping, laundry, mode of transportation, responsibility for own medications and ability to handle finances. ADLs and IADLS must both be addressed in the documentation for annual wellness visits.


Last Updated Tue, 22 Dec 2020 16:29:40 +0000