Resource
Being ready for an audit is a documentation habit, not a project you run when the letter arrives.
Background
ADR requests, UPIC audits, TPE rounds, and RAC reviews all ask a version of the same question. Does the record prove that the care was necessary, that the patient was homebound, and that a physician certified it.
By the time a request lands, the answer is already fixed. What we can influence is what goes into the chart in the months before.
Ongoing
- Visit note auditing for homebound status and skilled need language
- Certification and face-to-face encounter documentation checks
- Verbal order signature tracking, with an aging list
- Pattern reporting so repeat gaps reach the right supervisor
When a request arrives
- Full episode packet assembly in reviewer-friendly order
- A cover summary listing what is enclosed and where to find each element
- Clinical narrative support for the medical necessity argument
- Appeal drafting through all five stages of the CMS process
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