Happenings

Division 28 Celebrates Q3 Award Winners

Megan Gray, medical reviewer II, Data Strategy Department

Associate of the Month — July

Megan Gray

Division 28 has named Megan Gray, a medical reviewer II in the Data Strategy Department, the July Associate of the Month. Through her dedication and efficiency, she helped move over 300 providers through important review stages, ensuring their claims were reviewed quickly.

Megan’s wide-ranging knowledge of Medicare Part A, Part B, and Home Health and Hospice enhances her ability to switch between tasks and help wherever needed. She also took the lead in updating important work instructions to ensure everything completed according to guidelines. Megan is often the first to volunteer for new challenges, showing her reliability and strong work ethic. Her colleagues respect her and appreciate her willingness to help the department achieve its quality objectives.

Jessica Brewer, senior medical reviewer, Medical Review Part B

Associate of the Month — August

Jessica Brewer

Jessica Brewer has been recognized as the August Associate of the Month. As a senior medical reviewer in the Medical Review Part B Department, she plays a vital role in explaining the medical review process to both providers and staff. Jessica ensures that all metrics are met by checking each reviewer's daily workload and following the aging claims report multiple times a day. She is also responsible for sending daily workload assignments and addressing any review issues that arise. Jessica's efforts in maintaining communication and implementing process improvements make her a trusted and essential member of the team.

Richard Murphy, accounting technician III, Provider Audit

Associate of the Month — September

Richard Murphy

Recognized for his positive and professional communication with providers, Richard Murphy, an accounting technician III in Provider Audit, is the September Associate of the Month. During his first year with Palmetto GBA, Richard has demonstrated significant growth as both a preparer and reviewer.
In October, Richard took on the supervisory role for some important reviews and successfully tackled a complex task that was new to him. His commitment to listening and asking insightful questions contributed significantly to his success.

Karen Warren, medical coding specialist, Medical Review Medicare Part A

Coach of the Quarter

Karen Warren

Named the Coach of the Quarter, Karen Warren, a medical coding specialist in Medical Review Medicare Part A, is always willing to help and train others with her expert knowledge of coding. Karen makes learning about coding fun and engaging. Her encouragement has inspired many, including one of her trainees who is now pursuing coding certification outside of work, thanks to Karen's guidance. When she discovered that a trainee was taking coding classes, she generously spent her own money to provide them with coding textbooks, even though these books can be quite expensive. Her thoughtful gesture is just one example of her wonderful character and dedication as a trainer.

Team of the Quarter

JM Audit Supervisors

Team members: Daniel Jordan, Dhara Patel, Stephen Wood

The Medicare Jurisdiction M Audit supervisors have excelled all year but are being recognized as the Team of the Quarter for their exceptional teamwork during the third quarter. Their notable efforts include leading their teams in the Audit and Reimbursement Department to complete cost reports and a special change request detailed in a technical direction letter from the Centers for Medicare & Medicaid Services. In addition to completing their regular workload, they also collaborated with other departments to prepare and present the first Provider Open Forum on Wage Index for Provider Audit and Reimbursement, which was well received and well attended. They rallied despite the challenges, producing high quality work and excellent quality scores.

 

Process Improvement of the Quarter

Initiation of CERT Second Letter Process

Team members: Ashley Baker, Jennifer Greer, Jennifer Williams

The Comprehensive Error Rate Testing (CERT) Medical Review team is being recognized with the Process Improvement of the Quarter award for their Initiation of the CERT Second Letter Process. Prior to the process improvement, the CERT review contractor would send up to four letters to the billing provider to get medical records but would not send an additional documentation request to a third-party provider unless the Medicare Administrative Contractor (MAC) or the provider requested it.

To address the issue, the Medical Review team started emailing the CERT contractor to send requests directly to third-party providers, like hospitals or nursing facilities, after the second letter for Part B claims. As a result, third-party providers responded without needing extra requests. The response rates in June, July and August improved significantly, reducing errors due to non-response or insufficient documentation and lowering the overall CERT error rate.