CMS begins new round of recovery audit contracts, says improvements will be seen

Promised RAC improvements could mean more targeted doc requests.
Promised RAC improvements could mean more targeted doc requests.

Connolly LLC will be the recovery audit contractor responsible for reviewing durable medical equipment, hospice and home health claims on a nationwide basis, the Centers for Medicare & Medicaid Services recently announced. This kicks off the new round of RAC contracts, and promised changes to the program now will start to be implemented, CMS stated.

RAC activity has been severely curtailed since February 2014, as the last round of contracts came to an end. Healthcare providers, including long-term care providers, have argued that RACs have become overly aggressive in identifying potential Medicare overpayments. A crippling backlog of appeals has developed. CMS pledged that improvements would be made with the next round of contracts.

These improvements are meant to “reduce provider burden and increase transparency,” CMS stated in a Dec. 30 announcement. They include limits on additional document requests, changes in how RACs are paid and timelines for communication with providers. Many of these changes now will begin to be implemented as Connolly and other newly contracted auditors begin work, according to CMS.

Connecticut-based Connolly is the first RAC to oversee claims across the entire country, and the first to focus on DME, hospice and home health claims. These types of claims have “historically been riddled with billing errors,” stated Kristin Walter, spokeswoman for the American Coalition for Healthcare Claims Integrity, an auditor association.

CMS has yet to announce the four regional auditors that will review other types of Medicare claims. Connolly has been the RAC for Region C since the auditor program was established in 2006, the company noted in a press release. Region C includes 17 states and territories in the South.