How to Prepare for and Respond to a Medicare ADR
Under 42 CFR Section 405.903, providers have 45 days to respond to a MAC, RAC, or SMRC request, and 30 days for a UPIC request, with no medical record review conducted if that window is missed. Medicare ADR home health response packages must mirror the reviewer's evaluation order, since agencies without a documented, repeatable protocol take longer to assemble complete records and generate a higher share of unfavorable determinations.