CMS to Pilot ADR Request for Radiology Services

On October 30, 2020 CMS announced a pilot process to enable Medicare Administrative Contractors (MACs) to receive pertinent documentation from the treating/ordering provider during medical record review, in an effort to support the necessity and payment for radiology service items billed to Medicare.


Change Request 11659 (Transmittal 10412) becomes effective December 1, 2020. Currently, when the MAC requests medical records from the provider of services, the provider is responsible for gathering all of the supporting documentation. That could mean a radiology service provider might have to reach out to the ordering physician’s office for supporting documentation. Sometimes the provider is not successful in obtaining the documentation. This Change Request requires MACs to conduct third-party additional documentation requests (ADRs) for radiology service claims, when necessary, from the treating/ordering practitioner (physician’s office or inpatient facility).

The MedLearn Matters is available at https://www.cms.gov/files/document/mm11659.pdf
The CR11659 is available at https://www.cms.gov/files/document/r10412otn.pdf