Connolly serves both Medicare managed care plans and the Centers for Medicare and Medicaid Services (CMS) itself with identifying and recovering overpayments. We uncover the root cause of those overpayments and provide actionable recommendations to reduce or eliminate future errors.

Below is an overview of just some of the many claim types Connolly will review to identify improper payments in the areas of:

• Retro-termination
• Coordination of benefits
• Provider billing compliance
• Multiple payments
• Contract compliance
• Chart review / hospital bill audit
• In-patient DRGs (MS-DRG) for potential up-coding
• Hospital in-patient length of stay for excessive duration, medical necessity, validation, and outlier payments
• High-cost injectibles and IV drugs administered in an out-patient or clinic setting
• Duplication of services between in-patient and out-patient care settings

Connolly Healthcare was selected as the Recovery Audit Contractor (RAC) for the CMS Demonstration Project (2005-2008) and was responsible for identifying and recovering improper payments in the states of New York and Massachusetts. Connolly reviewed four years of paid claim data totaling in excess of $80 billion ($20 billion per year for four years). During the three-year project, Connolly recovered $270 million in improper payments while minimizing disturbances to CMS's providers. In October 2008, CMS awarded Connolly the country’s largest region, Region C, for the RAC Natonal Expansion Program.

For more information on the RAC program including provider contact information, record submissions, and CMS approved issues, please click here: