Reimagining the coding update process leads to significant time savings

Law Enforcement agencies, the Federal Protective Service (FPS) and benefit investigations often request provider claims history from the Railroad Retirement Board Specialty Medicare Administrative Contractor’s (SMAC) Benefit Integrity (BI) Unit.

Originally inquiries were run utilizing the Provider Transaction Access Number (PTAN). The team determined that running the reports using the National Provider Identifier (NPI) instead of the PTAN streamlined the process on a couple of fronts. The FPS already provided NPI numbers, so this implementation eliminated the need to look up the associated PTAN query. A search can be completed using the NPI for the organization. These efficiencies resulted in significant cost and efficiency savings and earned this team Process Improvement of the Quarter.

Team Members:
Richard Altobello, Van Dixon, Taryn Herrmann, Tammy Keel, Ricky Newton, Becki Stroud and Debra Watson

Accuracy and speed earn this group Team of the Quarter

The Document Control (DC) Augusta team played a significant part in the successful End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) Validation study. The team imported all records received from designated dialysis facilities into the Palmetto GBA workflow system and indexed all related documents. In total they inputted close to 2,500 medical records for nurses to review. The DC team, facing a quick turnaround time, imported all of the records within 1-2 days of receipt with excellent accuracy. Their diligence insured the project finished on time.

Team Members shown left to right:
Standing: Myra Christian, Selena Haskins, Cathy Stroud, Janet Costello and Garrett Black.  Seated: Yvonne Marshall and Belinda Campbell. Not pictured: Sally Mika (Medical Review)

Coach of the Quarter awarded to Janet Pleiman for the many hats she wears

Janet Pleiman was initially hired as a Medical Reviewer III in the Benefit Integrity (BI) department. She then transferred to the Appeals department in November 2019, while continuing to dedicate time to assist with BI reviews.

Janet took on a new role, training BI review clinicians. Additionally, she trained Medical Review clinicians who started assisting with BI reviews. Janet added one more role to her workload as a review coordinator. In this role she analyzed pending reviews and delegated them based on the clinician’s area of expertise.

Janet has gone above and beyond for the Benefit Integrity department since transferring to another unit and has performed well for both departments. Since Janet’s transfer she has closed 104 investigations. The new BI and MR clinicians have closed a total of 34 reviews under her guidance.

Associates of the Month for Third Quarter 2020

July – Myra Christian, Document Control Coordinator
Myra demonstrates excellent ability and knowledge. She is always willing to teach and is a strong and patient leader. Myra’s manner of explaining is comforting and gives you confidence in your job.

August – Jennifer Williamson, Medical Reviewer III
Jennifer is a team player. She often accepts special assignments and works tirelessly behind the scenes holding many processes together. In addition to Medical Review, Jennifer also knows the post payment review process and readily assists with projects. On multiple occasions she has volunteered to work in a training capacity adding to her regular workload. Jennifer never seeks attention or accolades for her contributions. She believes in excellence through teamwork.

September - Marian Kennedy, Reporting Specialist
The COVID-19 pandemic has upended many things including requiring a new Medical Review process for the Centers for Medicare & Medicaid Services. Marian’s positive attitude, perseverance, helpful spirit, diligence and flexibility helped our Medical Review team accomplish their goals during this unprecedented time. Her efforts behind the scenes to help navigate many tasks involved with the Medical Review department’s requirements were greatly valued.