How are Additional Documentation Request (ADR) limits determined under the Recovery Audit Program?

The determination of Additional Documentation Request (ADR) limits under the Recovery Audit Program is closely related to the provider's compliance with Medicare rules. When a provider demonstrates a history of compliance, they may be subject to fewer ADRs, reflecting their adherence to regulations and their established billing practices. This approach encourages providers to maintain high standards of compliance, ultimately benefiting not only their practice but also the integrity of the Medicare system.

While elements like a facility's revenue or numbers may play a role in the overall audit strategy, they are not the primary determinants for ADR limits. Additionally, uniformity across all providers does not account for variations in compliance levels; hence, ADR limits are tailored rather than applied equally to all. Finally, individual Recovery Auditors propose strategies, but the framework for ADR limits is based significantly on a provider's documented compliance, making that aspect critical in understanding how limits are set.