Progress | Advancements

gettyimages-1131145241-170667a_advancements.jpg

Achievement Through Adaptability

 
 

Great challenge is often found in periods of transition. So is opportunity.

The transition of the Centers for Medicare & Medicaid Services (CMS) Jurisdiction J (JJ) A/B Medicare Administrative Contractor (MAC) contract to Palmetto GBA afforded us a tremendous occasion to excel. Recognized by CMS for “exceptional problem-solving skills,” as well as for its “excellent and collaborative relationship with CMS,” Palmetto GBA was able to serve as “an important partner to CMS in determining effective solutions throughout the Base Year.”1

Not only were we able to ensure there were no provider payment disruptions, but we also assumed operations successfully as of each segment cutover date without incident. And, we reduced a significant volume of backlog in nearly every operational area. Our success came from the flexibility and adaptability of everyone on the Palmetto GBA team.

 
 

Here are a few highlights

Working together, in 2018 we:

  • Realigned each area’s cutover strategy to accommodate for older-than-anticipated workload, proprietary file formats and late access to previous staff

  • Implemented early interventions on interactive voice response and call routing changes to bring initial spike in average speed of answer (ASA) under control within two weeks (to average 38-second ASA)

  • Investigated and handled an inventory of more than 100,000 pending work items and 41,000 Part B appeals unclassified work items

  • Resolved large majority of more than 11,000 aged pending Part B Provider Enrollment applications

  • Identified numerous claims processing issues, quantified errors and offered solutions for correction

  • Expanded website portal features to enable providers to submit wage index and other audit and reimbursement documents electronically, as well as added a cost report look-up tool

  • Participated in workgroups and established good relationships with other MACs, CMS and external stakeholders

  • Worked with the National Association of Rural Health Clinics to identify education opportunities and establish an escalation process for its members, and worked with stakeholders to communicate specific Rural Health Clinic information for Medicare Advantage Plan overpayments

  • Partnered with the Georgia Society of Clinical Oncology to educate providers on new claims processing protocols

  • Established partnership to manage and respond to escalated beneficiary and provider constituent inquiries at the request of the Senate Health, Education, Labor & Pensions Committee


1. Taken from CMS award letter.

 
 
 

2018 Annual Numbers

 
 
benefits_Y1.png
 
claims_Y1.png
 
 
beneficiaries_Y1.png
 
inquiries_Y1.png
 
 
B3_annual_numbers_Y1_Award_criteria copy 7.png
 
B3_annual_numbers_Y1_Award_criteria copy 5.png
 
 
employees_Y1.png
 
B3_annual_numbers_Y1_Award_criteria copy 2.png
 
 
GBA_LightWarmGray.jpg