CMS awards national recovery audit DME contract

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On December 30, 2014, the Centers for Medicare and Medicaid Services (CMS) awarded the first national recovery audit contract to Connolly, LLC, a subsidiary of Connolly iHealth Technologies. The contract is for Region 5, which is national in scope and includes Medicare claims for Durable Medical Equipment and Home Health and Hospice (DME/HH-H).

CMS previously determined that it would select recovery auditors to review Medicare claims within four geographic regions of the country, and a new fifth nationwide region focused on identifying overpayments and underpayments specifically among DME/HH-H claims. Connolly currently provides similar payment integrity services to private healthcare insurers to help lower systemic costs and improve healthcare payment accuracy.

“Connolly looks forward to working with DME/HH–H providers to ensure fairness and accuracy across the Medicare system. This contract will benefit the entire Medicare program, including providers, who will know that they are being reimbursed accurately and consistently, Medicare beneficiaries who depend upon those services, as well as taxpayers who demand that the Trust Fund be protected,” said Connolly iHealth Technologies Vice President of Audit Operations Chad Janak, who oversees the Company’s CMS work.

Connolly has continuously served CMS as a Recovery Audit Contractor since the inception of the program, as mandated by the Tax Relief and Health Care Act of 2006. Connolly is currently the exclusive recovery audit prime contractor for Region C, which covers 17 states and territories in the southern portion of the US.

“We are pleased to be continuing our partnership with CMS and are honored to have been chosen as the first national contractor for DME/HH-H claims,” Connolly, LLC President Steve Senneff said.

About CMS Recovery Audit Contract Program
Congress mandated the creation of the recovery audit contractor program in order to review a small percentage of Medicare claims and identify billing errors. Since the program began in 2009, recovery auditors have returned more than $8.9 billion to the Medicare Trust Fund, while reviewing less than 2% of Medicare claims from any given provider. Recovery auditors have also returned more than $800 million in underpayments to providers. In Fiscal Year 2013, an independent validation contractor found that recovery auditors had an average accuracy rate of 96.4%.

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