When you get an ADR (Additional Documentation Request) or a survey citation, how you respond matters. Panic and defensiveness don’t help; a clear, factual response does. If the letter comes from a Medicare Unified Program Integrity Contractor (UPIC, the successor to ZPIC), the same discipline applies, but the stakes on timing and extrapolation can be higher. See our guide on Medicare UPIC and ZPIC audits for home health for letter types and packet structure. Experienced managers keep a small playbook so the first response isn’t ad hoc: who gathers the docs, who writes the cover letter, and what the timeline is.
Responding to ADRs
You have a deadline,usually 30–45 days. Send exactly what they ask for: the specific documentation that supports the claim. Don’t send the whole chart unless they ask. Include a short cover letter that points to the relevant sections (e.g. “Face-to-face encounter is on page 3; physician order is on page 5”). If you don’t have the doc, say so and explain what you’re doing to prevent it next time. Don’t invent or alter documents. Track ADR volume and reasons: if you’re getting the same request repeatedly (e.g. “F2F not in chart”), that’s a process fix,see face-to-face documentation requirements so it doesn't happen again,not just a one-off response.
Plan of correction (survey)
For a survey citation, you’ll submit a plan of correction: what you’ll do, who’s responsible, and by when. Be specific. “We will train staff” is weak; “DON will conduct in-service on [topic] by [date]; attendance will be documented” is better. Then do it. Survey agencies follow up; if your plan wasn’t implemented, you’re in worse shape. Use a template so every PoC has the same structure: deficiency, root cause, action, owner, due date, and how you’ll verify.
Preventing the next one
Every ADR and citation is data. Categorize by cause (missing F2F, order mismatch, late OASIS, etc.) and fix the top one or two at the process level. One agency’s ADR rate dropped sharply after they added a 5-item pre-bill check and made it mandatory. Having a playbook on file,ADR steps and a PoC template,means the next time something hits, you’re not starting from scratch.
We have an audit defense playbook you can download: ADR response steps, cover letter pointers, and a plan-of-correction template. Use the button below to get it.