An Additional Documentation Request is not an accusation. It is a deadline. The agencies that handle them badly are not the ones with bad care, they are the ones who have to go and find out what their own chart says.
The clock
You generally have 45 days. Treat it as 20. The remaining time is for the things you will discover are missing, like a verbal order that never got signed or a face-to-face encounter note living in a fax queue.
What goes in the packet
- The full episode, in date order, with a cover sheet that says what is included
- Certification and recertification statements, signed and dated
- The face-to-face encounter documentation, with the clinical findings visible
- Every visit note for the period under review, including missed visit notes
- Physician orders, including verbal orders with the signature date
Send it in the order a reviewer would read it. If they have to hunt for the certification, they will form an opinion about the rest of the chart before they find it.
The part that actually decides the outcome
Homebound status and skilled need have to be visible in the narrative, not implied by the diagnosis. "Patient ambulates with walker" is not homebound status. "Requires maximal assist of one and becomes short of breath after twenty feet, unable to leave home without assistance" is.
This is why routine visit note auditing pays for itself. By the time an ADR arrives, the language is either in the chart or it is not, and nothing you write in the cover letter changes that.
Gravita Clinical Desk · 2 June 2026
