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CMS Recovery Audit Program

Healthcare costs are rising steadily, putting stress on our economy and our families. With as many as 10%* of all insurance payments made in error, Connolly’s work to identify errors and address their root cause can help improve healthcare and make it more affordable for all of us.

The Recovery Audit program is a cost containment effort aimed at reducing improper payments within Medicare programs as well as identifying process improvements to reduce or eliminate future improper payments. Connolly was the prime contractor for NY State in the Medicare RA demonstration project and was subsequently awarded the contract to provide Medicare recovery audit services for CMS as mandated by the Tax Relief and Health Care Act of 2006. Connolly is the exclusive RA prime contractor for region C, the largest region, covering 35% of all claim volume from 17 states and territories in the southern portion of the US. To date, the program has resulted in the correction of more than $8 billion in erroneous payments.

 

*In its FY 2013 Agency Financial Report, The Department of Health and Human Services reported an overall fee-for-service error rate of 10.1 percent, representing $36.0 billion in improper payments

 

For additional information about the program, visit the following websites:

RA Program Overview
CMS RA Program FAQs
CMS RA Program Myths
American Coalition for Healthcare Claims Integrity -- Properpayments.org
CMS Manuals
Medicare Coverage Database
American Hospital Association FAQs

 

Connolly Healthcare
555 North Lane Suite 6125
Conshohocken, PA 19428
 
866.360.2507 | 203.529.2995(F) | racinfo@connolly.com

 

 

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What the Press is Saying...
"It is no surprise that Connolly is the first RAC to post manual medical reviews of therapy claims above the $3,700 threshold as issues, as it was the first RAC to roll out provider education as the permanent program got under way (as well as the first RAC to post automated issues, including the outpatient issue related to billing of untimed codes)."
 
Nancy J. Beckley
RACmonitor