Medical Review & the Targeted Probe & Educate (ADR) Process: FAQs & Tips to Successfully Maneuver Audits

Date/Time: 09/22/2021 - 09/23/2021, 9:00 am - 4:30 pm

Provider: FHPCA

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This is a 90-minute webinar.

9:00 am – 10:30 am HST
11:00 am – 12:30 pm AKT
12:00 pm – 1:30 pm PT
1:00 pm – 2:30 pm MT
2:00 pm – 3:30 pm CT
3:00 pm – 4:30 pm ET

OIG reports in 2018 and 2019 identified payment and quality-related problems in hospices. As a result, audits and medical reviews increased, impacting many hospice agencies. As we transition from a Public Health Emergency, it is anticipated that this trend of increased audits will rise even more for both hospice and home health.


  • Define fraud and abuse and the different types of government audits
  • Explain agency responsibilities, critical timelines, and the ADR process, also known as Targeted Probe and Educate (TPE)
  • Identify critical compliance areas to minimize audits and ADRs (TPE)
  • Identify when an agency should appeal a denial


This webinar will review the FAQs related to audits and the medical review process. It will explain the process, agency responsibilities, and where agencies should focus. Discover how to minimize denials and partial denials to targets, probes, and audits. Learn the proper way to submit documentation and the timeline to follow. Participants will also review sample cover letters and the presenter will address when to appeal, when not to appeal, and when to utilize outside resources to increase your agency’s opportunity for a favorable outcome.


This informative session will contain excellent information for all agency personnel. Administration, finance, clinical management, supervisors, QAPI staff, medical directors, board members, liaisons, and intake staff will all benefit from attending.


  • ADR post-payment review letter example
  • Guide for Responding to ADRs
  • Medicare Program Integrity Manual
  • NGS Hospice Documentation Checklist/CMS Hospice Documentation Checklist
  • Links to:
    • Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Guide
    • Postpayment Medical Review Additional Development Request (MR ADR)
    • Prepayment Medical Review Additional Development Request (MR ADR)
    • User Manual Medical Review Tab Jurisdiction 15
    • Additional weblinks to resources and tools
  • PDF of slides and speaker’s contact info for follow-up questions


Photo Kathy Ahearn
Ahearn Advisement Partners

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