February 7, 2013

Providers Beware: Home Health Agencies in Region B Receive Records Requests from Connolly in Region C

By

I was consulting with a home health agency in Illinois a couple of days ago when an agency representative mentioned that they had received a request for documentation from their RAC. I began to talk about CGI, the Region B auditor, when the representative mentioned that the letter was from Connolly. I recommended that the agency contact Connolly to ask why it would be requesting documentation, since they were not the auditor for Illinois.

The provider proceeded to contact Connolly and was informed that Connolly had been given authorization to perform RAC audits for any agency billing Palmetto, regardless of the region in which the provider is located.

The agency was prepared to submit the records to Connolly as instructed, but I still was concerned about the response. Our team at FR&R Healthcare obtained the contact information for the CMS Region C project officer and requested confirmation that Connolly had been approved to conduct audits outside of the states in their region. 

Scott Wakefield from the CMS Division of Recovery Audit Operations confirmed that Connolly only may perform audits for home health and hospice providers in Recovery Audit Region C states. Thanks to the quick response, the provider avoided sending medical records to an auditor that did not have the authority to conduct an audit on its claims. I can only imagine the confusion and potential nightmare it could have been to resolve any improper payment identified by a contractor that did not have the authority to review the record. 

Agencies must be acutely aware of who is requesting documentation and always check with their CMS RAC region contacts if they have any questions regarding a request. The following table lists the Recovery Auditors for each home health and hospice region, as well as the contact information for the CMS project officer for each region.

Region

Contractor

States included in Region

CMS Project Officer

A

Performant Recovery, Inc.

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont

Tamara Tate

Email: tamara.tate@cms.hhs.gov

Phone: 410-786-1128

 

 

B

CGI

Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin

Diane Earl

Email: diane.earl@cms.hhs.gov

Phone: 410-786-3037

C

Connolly Consulting, Inc

Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia

Scott Wakefield

Email: scott.wakefield@cms.hhs.gov

Phone: 410-786-4301

D

Health Data Insights, Inc.

Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming

Narcessa Davis

Email: Narcessa.Davis@cms.hhs.gov

Phone: 410-786-2915

 

 

About the Author

Bonny Kohr, RN, CHCE, HCS-D, is the manager of clinical services for FR &R Healthcare Consulting, Inc. She is a registered nurse, certified homecare coding specialist, and certified homecare and hospice executive. Bonny has worked 23 years in home health care, beginning as a field staff nurse, then as a clinical director, and finally as the chief operating officer.

Contact the Author     

BKohr@frrcpas.com

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Bonny Kohr, RN, CHCE, HCS-D

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