Progress | Growth

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Strides Forward

 

Growth Initiative

Achievements at the Highest Levels – CMMI Level 4

As a part of Palmetto GBA’s strategic focus on process re-engineering and improvement, we pursued Capability Maturity Model Integration (CMMI) Maturity Level 4 in 2018. Over the project life cycle, our team developed complex statistical models to improve productivity and quality throughout the organization. In July, Palmetto GBA achieved the Level 4 rating, distinguishing the organization from competitors and positioning us to deliver even greater value to customers.

The CMMI Institute is the global leader in advancement of best practices in people, process and technology. The CMMI models were developed by The Software Engineering Institute at Carnegie Mellon University and industry and government representatives. A Maturity Level 4 appraisal means Palmetto GBA demonstrates the ability to manage and quantitatively predict the performance of processes, enabling our team to proactively identify potential corrective actions.

To receive a Maturity Level 4 assessment, Palmetto GBA had to demonstrate statistical and quantitative use of metrics, shift to proactive and predictive measures, and demonstrate upward of 98 percent accuracy for productivity and quality. The CMMI Level 4 achievement is extremely difficult to obtain; only a small number of software development organizations achieve the distinction.

 
 
 
 

New Business


Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT)

Palmetto GBA was awarded the Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) contract. Its purpose is to identify alternate transportation resources for beneficiaries who do not receive approval for RSNAT; communicate with the affected beneficiaries; and track and report required information to the Centers for Medicare & Medicaid Services (CMS). Registered nurses and licensed social workers take calls directly from Medicare beneficiaries and/or their authorized representatives. This interaction includes a discussion of the denied decision to determine if the request is appropriate. Beneficiaries are either referred back to their ambulance supplier or provided assistance to help secure other methods of transportation.

Pricing, Data Analysis and Coding

Palmetto GBA is contracted by CMS to assist suppliers and manufacturers in the proper use of the Healthcare Common Procedure Coding System (HCPCS) through the Pricing, Data Analysis and Coding (PDAC). The HCPCS is used to identify items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for purposes of Medicare billing. The PDAC’s contract operations support the Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), CMS, federal law enforcement agencies, and the National Supplier Clearinghouse.

As the PDAC, Palmetto GBA performs the following activities:

  • Supports the integrity of the Medicare DMEPOS benefit


  • Advises manufacturers and suppliers on the appropriate HCPCS for billing DMEPOS items


  • Receives, evaluates and processes coding verification applications for DMEPOS


  • Establishes, maintains and updates all coding verification decisions on the Product Classification List housed within the Durable Medical Equipment Coding System (DMECS)


  • Establishes, maintains and distributes the National Drug Codes (NDC)/HCPCS Crosswalk and Oral Anti-Cancer Drugs (OACD) pricing files


  • Conducts DMEPOS statistical analysis and reporting: www.dmepdac.com


FISS Code Editor Support Contract

StrategyGen is contracted with CMS to provide a variety of coding support services. Because of our business relationship, proven performance and demonstrated expertise, StrategyGen awarded a subcontract to Palmetto GBA on the Fiscal Intermediary Standard System (Medicare) FISS Code Editor Support Contract. Palmetto GBA provides expertise regarding the code editing modules used by the standard claims processing systems. We support StrategyGen’s efforts to identify recommendations for revision or deletions to the code editing modules, as well as analysis regarding the downstream impact of potential coding changes.


VA Program Management Support Services (PMSS)

As a subcontractor to Tista Tech, Palmetto GBA will provide Agile Development Support for the VA Program Management Support Services. This contract delivers program management support for the VA Financial Service Center, which is a franchise fund operation providing payroll processing, data analysis and other administrative services for the VA and other federal agencies.

National institute of Diabetes and Digestive and Kidney Disease Clearinghouse

Palmetto GBA’s Celerian Group partner, JBS International, was awarded the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Clearinghouse contract for the National Institutes of Health (NIH). Palmetto GBA’s role in this contract is to provide clinical consultation.


CIO-SP3

NIH Information Technology Acquisition and Assessment Center (NITAAC) was designated a federal Executive Agent, authorized by the Office of Management and Budget (OMB) to administer three Government-Wide Acquisition Contracts (GWACs) for information technology procurement: CIO-SP3, CIO-SP3 Small Business and CIO-CS.

These GWACs can be used by any federal civilian or Department of Defense (DoD) agency to acquire information technology products, services and solutions.

Palmetto GBA currently holds a CIO-SP3 GWAC as a subcontractor to Stinger Ghaffararian Technologies, Inc. In 2018, we sought additional CIO-SP3 contracts. Palmetto GBA participated on several CIO-SP3 teams, and as a sub-contractor, our teams were awarded two CIO-SP3 contracts for small business on ramp. The CIO-SP3 Small Business GWAC is a 10-year Indefinite Delivery/Indefinite Quantity (IDIQ) contract intended to provide information technology (IT) solutions and services for health and biomedical operations that include meeting scientific, health, administrative, operational, managerial and information management requirements. These partnerships open up significant business development opportunities for Palmetto GBA.

CIO-SP3 contract holders go through a rigorous source selection process prior to award, ensuring the pool of contractors is the best-of-the-best, resulting in significant time, money and resource savings.

 
 
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Demonstration Project

The Home Health Pre-Claim Review (HH PCR) was re-implemented by CMS as the Review Choice Demonstration (RCD) with issuance of a Jurisdiction M contract modification in early June. This official action by CMS resulted from Palmetto GBA’s dedication to the demonstration and the presentation of persuasive data illustrating the significant value of the demonstration to the CMS trust fund. Production for the demonstration is expected to launch in spring 2019.