Coach of the Quarter – Ursula Caldwell

Ursula Caldwell, a Provider File Operations Supervisor, is highly respected by her team and peer managers. She is actively involved in developing the skills and talents of all associates in her area. She has successfully developed her team to perform analysis and review complex application situations and inquiries from the Centers for Medicaid and Medicare Services (CMS) and the provider community. Ursula provides ongoing feedback and assessments to her team and holds individual sessions to review policy updates. She is an excellent trainer and can effectively present information in a way that is easily understood by the analyst. For her strong leadership skills and dedication to her team, we are excited to announce Ursula Caldwell as our Division 1M5M6M Coach of the Quarter.

Team of the Quarter - Reason Code C7010 Claim Overlap Reduction Team

For a Medicare beneficiary who elects hospice, an individual is considered terminally ill if life expectancy is 6 months or less, or if the illness runs its normal course. Only care provided by (or under arrangements made by) a Medicare-certified hospice is covered under the Medicare hospice benefit. If the service is related to the hospice condition, the other provider's claim would show that the beneficiary has elected the Medicare hospice benefit, and services are billed as being related to the terminal diagnosis by a non-hospice provider. This team, to reduce the number of claim denials, held a webcast conference for home-health providers and answered questions, explained processes and more. Since this webcast, there has been a decrease of over 1,400 occurrences of the incorrect reason code and over 280 decreases in occurrences for Jurisdiction M Part A, for a total decrease of nearly 1,700 occurrences for inaccurate reason codes. Congratulations to this team on being named our Division 1M5M6M Team of the Quarter.

Team Members: Charles Canaan, Areka Freeman, Janae Garrett, and Dan George

Process Improvement of the Quarter - Group End Stage Renal Disease (ESRD) Tentative Settlement Template

In the Reimbursement Team, they issue tentative settlements to providers. By using excel templates to help calculate the tentative settlement amounts for providers, this team can be more automated, helping complete reviews more accurately and timely. The Group ESRD tentative settlement template allows for up to 25 providers to be processed at once and also pulls data needed from reports from STAR (System for Tracking Audit and Reimbursement). This more automated and accurate process improvement results in significant cost savings annually.

Team Members: Barbara Campbell, Marcella Cannon, David Glass, Julianne Green, Latacha Gregerson, Robin Moses, and Jenifer Raffaele

Associate of the Month (April) - Patsy Barkley

Patsy Barkley, a Customer Service Coordinator (CSC), started working in the Provider Call Center (PCC) for Jurisdictions J and JM, Part B Medicare in March of 2018. Patsy quickly learned the ins and outs of Medicare. She enjoyed researching audit codes and denials while advising her peers on what she had learned. In 2021, Patsy’s job responsibilities were expanded to include Freedom of Information Act (FIOA) requests, reporting, record obtainment, customer service, and more. Her team says it best: "We are excited to see Patsy grow in the company and her career. Her willingness to be a great team player exemplifies the characteristics of an Associate of the Month! " Congratulations Patsy.

Theresa.

Associate of the Month (May) - Brenda Petke

Brenda Petke, a Lead Auditor, is an outstanding member of her team. She volunteers to mentor other team members who need additional training and encouragement. Brenda works with our Ambulatory Surgery Centers (ASC) to clarify issues and has built great relationships. She diligently shares information she learns with her team members and often creates resources for all to use. Brenda also has extensive experience in Medicare reimbursement and auditing. Brenda is kind, compassionate, and hard-working, and for this reason, we are excited to announce her as our May Associate of the Month for Division 1M5M6M.

Associate of the Month (June) - Keiona Henry

Keiona Henry, a Senior Provider Relations Representative, is an important part of the Provider Outreach and Education (POE) team and brings valuable experience as a Provider Contact Center (PCC) Customer Service Coordinator. Training experience and customer service are integral parts of what this team does as educators and as an outward-facing part of the company. Keiona has stepped in to assist with tasks on behalf of the team, such as reviewing documents for CMS and more. Her steadfast dedication to continuous improvement is why we are excited to announce Keiona as our June Associate of the Month for Division 1M5M6M.