ADR vs RAC audit
An ADR is a Medicare Additional Documentation Request — the MAC asks for records before paying or after paying a specific claim. A RAC audit is a contingency-fee post-payment audit by a Recovery Audit Contractor.
Last reviewed May 24, 2026
Side by side
ADR (Additional Documentation Request)
A Medicare contractor's written request for medical records to substantiate a claim. Issued by the MAC, RAC, SMRC, UPIC, or CERT.
Medicare Program Integrity Manual Ch. 3- Strict 45-day response window (Medicare).
- Failure to respond = denial.
- Can be prepayment or postpayment.
RAC audit (Recovery Audit Contractor)
Postpayment audit by a CMS Recovery Audit Contractor paid on a contingency-fee basis to identify and correct improper Medicare payments.
Medicare Program Integrity Manual Ch. 3, 13- Issues ADRs as the mechanism to collect records.
- Limited look-back period (currently 3 years).
- Findings can be appealed through the standard 5-level Medicare appeals process.
When to use ADR (Additional Documentation Request)
- Recognizing the letter format — "Additional Documentation Request" with a specific list of claims and required records.
When to use RAC audit (Recovery Audit Contractor)
- Recognizing the letter is from a named RAC (Performant, Cotiviti, etc.) and references the Medicare RAC program.
Common mistakes
- Treating ADR and RAC as alternatives — they are not. A RAC audit reaches you through an ADR.
- Missing the 45-day clock — denial is automatic when records are not received in time.
- Failing to appeal a RAC denial within 120 days of the initial demand letter (Level 1 redetermination).
Sources
- CMS — Recovery Audit Programhttps://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/recovery-audit-program
- CMS Program Integrity Manual Ch. 3https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019033
Related
Track ADR responses in the SRA readiness check
Open sra studio →D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.