Alabama: Contractor's bad rep precedes it

 - 
Friday, February 20, 2015

BIRMINGHAM, Ala. – Blue Cross Blue Shield (BCBS) of Alabama has tapped Connolly to audit Medicaid claims, and industry stakeholders are not happy about it.

“Our folks are scared to death they will have the same experience with BCBS claims that they’ve had with Medicare claims where Connolly is concerned,” said Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association. “Connolly has a record for denying Medicare claims for egregious reasons.”

The insurer made the announcement in December but provided little in the way of details, including whether or not Connolly would be auditing other providers besides DME providers, and what sort of limitations it might have to work under.

Of particular worry: BCBS doesn’t have an adequate process in place for appealing Connolly’s findings, says Hamilton.

“That’s a concern if they are going to start requesting inappropriate refunds on claims we’ve been paid,” he said.

Connolly is the recovery audit contractor for Medicare in Jurisdiction C, which includes Alabama, and was recently awarded a national contract to identify overpayments specifically for DME, home health and hospice. 

Connolly has drawn the ire of providers in the past by overreaching on audits, including seeking out older claims for power mobility devices that are less likely to meet current standards, or requiring proof of a sleep study when Medicare doesn’t pay for the study.

“Our BCBS rep was unaware of their bad reputation,” said Hamilton.

Tags: