Final answer:
When the MAC conducts a medical review and requests additional documentation, they issue an Additional Documentation Request (ADR). Healthcare providers need to respond promptly and provide the requested documentation to avoid claim denials or payment delays.
Step-by-step explanation:
When the MAC (Medicare Administrative Contractor) conducts a medical review and requires additional documentation, they issue an Additional Documentation Request (ADR). An ADR is sent to the provider requesting further documentation to support the claims submitted for reimbursement.
For example, if a healthcare provider submits a claim for a certain medical procedure, but the MAC finds the documentation insufficient, they may issue an ADR asking the provider to provide additional medical records or clinical notes.It's important for healthcare providers to respond promptly and provide the requested documentation to avoid claim denials or payment delays.