CMS Transmittal revising timeframes for submitting ADRs has been revised, one more time.

New Timeframe for Response to Additional Documentation Requests

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R566PI.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8583.pdf

3.2.3.2 - Time - Frames for Submission 

(Rev. 566, Issued: 01-07-15, Effective: 04-01-15, Implementation: 04-06-15) 

This section applies to MACs, RACs, CERT, and ZPICs, as indicated. 

A. Prepayment Review Time Frames 

When requesting documentation for prepayment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46. 

B. Postpayment Review Time Frames 

When requesting documentation for postpayment review, the MAC, CERT and RAC shall notify providers that the requested documents are to be submitted within 45 calendar days of the request. ZPICS shall notify providers that requested documents are to be submitted within 30 calendar days of the request. Because there are no statutory provisions requiring that postpayment review of the documentation be completed within a certain timeframe, MACs, CERT, and ZPICs have the discretion to grant extensions to providers who need more time to comply with the request. The number of submission extensions and the number of days for each extension is solely within the discretion of the MACs, CERT and ZPICs. RACs shall follow the time requirements outlined in their SOW.