Progress | Impact

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Meticulous Solutions

 

Medicare Administrative Contractor for Jurisdiction J

 

On February 26, 2018, Palmetto GBA successfully implemented the Centers for Medicare & Medicaid Services (CMS) Jurisdiction J A/B (JJ) Medicare Administrative Contractor (MAC), which covers the states of Alabama, Georgia and Tennessee. JJ MAC represents 6.9 percent of the national claim-volume workload. The CMS recognized Palmetto GBA for its exceptional and successful efforts related to this Contract Performance Assessment Reporting (CPAR) for the JJ MAC Implementation period of September 9, 2017, to January 28, 2018.

 
 
 
 

Medicare Integrity Program

Our program safeguard activities resulted in significant savings for Medicare.

 
JM A/B MAC

Jurisdiction M A/B Medicare Administrative Contractor

JJ A/B MAC

Jurisdiction J A/B Medicare Administrative Contractor

RRB

Railroad Board Specialty Medicare Administrative Contractor

Benefits Integrity n/a n/a $2,109,358
Medicare Secondary Payer $595,480,401 $409,049,393 $5,522,363
Medical Review $434,314,503 $419,999,868 $9,111,154
Medical Review Ambulance Prior Authorization $7,253,310 n/a n/a
Total $1,037,048,214 $829,049,261 $16,742,875
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Request for Advance Payment Suppression Process

 

Palmetto GBA’s innovative Request for Advance Payment (RAP) suppression process continues to produce savings for the Medicare program year after year. In 2018, this improvement created suppression of more than 11,000 RAPs for which final claims were never submitted. Using an average RAP of $362, the RAP suppression process resulted in $3.8 million in savings for the Medicare program.

Palmetto GBA has worked with CMS since April 2013 to implement a process to monitor home health RAPs. Based on the solution created by Palmetto GBA in collaboration with CMS, CMS issued instructions to all home health MACs in late June 2018 to implement a RAP suppression process.

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