Considered the P art A team motivator, Canaan shares his knowledge on all lines of business

As a Provider Outreach and Education Department veteran, Charles Canaan is a trusted resource for his colleagues. He not only helps research provider questions but also provides context to increase an overall understanding of the situation. He is always generous with his time in helping new employees. Charles also assists team members in creating educational materials by providing constructive criticism and praise for a job well done.

Along with his guidance within Palmetto GBA Charles plays a large role in the provider community. He works with Part A and Part B Medicare Administrative Contractors (MACs) on numerous projects. Charles has a strong presence with our Home Health and Hospice community participating in summits and webcasts and he works closely with state and national associations.

For the consistently excellent job he does in supporting our team, we recognize Charles Canaan as Coach of the Quarter.

Hospital Outpatient Department (OPD) Services Implementation ensures providers are knowledgeable on new Medicare rules

Beginning in mid-2020 the Centers for Medicare and Medicaid (CMS) required prior authorization for certain OPD services that were generally considered cosmetic. Extensive education was needed to make the provider community aware of these changes and to ensure that the proper authorization was requested.

Palmetto GBA was the first MAC to present online education utilizing a two-part webcast prior to implementation. Our team was also the first to publish easy to follow prior authorization checklists for each of the procedure types. The team created the OPD Prior Authorization Calculator, a unique innovation to Palmetto GBA, that providers use to track the validity of their Unique Tracking Number after submitting an authorization request.

Articles, FAQs and informative webcasts were created to provide blanketed coverage regarding the new rules. The initiative succeeded in educating providers on proper utilization. Claims decreased from third quarter 2019 to 2020 by 14% earning this group Team of the Quarter honors.

Team Members:
Sandra Booker, Charles Canaan, James Kirk, Katie McLean, Bonnie Miller, Paula Motes and Liz Nettles

Supplemental Security Income (SSI) Realignment Workpaper Template automation improves accuracy and efficiency

Before this team developed a streamlined and automated solution for the SSI realignment workpaper the hospital desk review workbook was downloaded, and 86 unnecessary tabs manually hidden.

Now, depending on the form that the cost report reopening uses, the new stand-alone template populates with only the necessary tabs, procedures and lines. The cost report is imported via the Health Financial Systems (HFS) Data Extractor reducing keying errors and decreasing additional time spent by the reviewer and auditor to approve the final report. A formula was also added to the master sheet to populate the appropriate SSI tables based on cost report beginning dates. Headers and references also are automatically updated. These improvements save approximately one hour for the reopening and appeals staff per file. The result was a savings of 300 man-hours per year and recognition as the Process Improvement of the Quarter.

Team Members:
Meredith Cate, Dawn Mackey and Rhonda Winchester

Associates of the Month

October – Kimberly Jeter
Kim, a Senior Claims Research Analyst and part of the Provider Contact Center Concierge Team, is always willing to assist others even when she has a full workload. Her determination to see everyone succeed motivates her.

In addition to her work with the Concierge Team she helps with written correspondence, answers phone calls when volume is high and responds to emails and Freedom of Information Act requests. Kim is always optimistic and looks for ways to do her job better and make work easier for others.

November – Allison Hoar
Auditor III Allison Hoar’s exceptional organization and dedication streamlined a large three-month CMS wage index project and resulted in its early completion this year.

Jurisdiction J MAC reviews all inpatient Prospective Payment System (IPPS) hospitals to define averages which will affect Medicare rates and payment. Allison sent notifications and documentation requests prior to the project start. She worked closely with Palmetto GBA staff, conducting training, assigning files and fielding questions. She then documented lessons learned to incorporate into next year’s training.

December – Crystal Bowen
Crystal Bowen, Business Analyst I, is recognized as December’s Associate of the Month in part for leading the Cost Reporting Technician (CRT) Team while their supervisor was on extended leave. During this time period she continued to handle her regular workload along with finalizing a process improvement for rejected cost reports and reprogramming the CRT Team’s primary program as a result of a change request that affected reports beginning January 1, 2021.

Crystal was an integral force in ensuring the teams metrics remained stellar during a very challenging month.