Reimagining the coding update process leads to significant time savings

The Part A Pricing team is responsible for updating the Fiscal Intermediary Shared System (FISS) Healthcare Common Procedural Coding System (HCPCS) files to ensure new codes are loaded for claims processing. Codes are often issued in between the set quarterly updates. Most frequently this is completed using a batch update. Historically, staff manually loaded criteria for a new code into the FISS batch update screen. Screen prints of the updates were then captured manually to document the updates for quality review. Each of Palmetto GBA’s six FISS processing regions were completed separately.

Team member Holli Maner, a Business II Analyst, found a solution to increase efficiency using the Millweb to enter batch updates. The needed updates are now entered into a spreadsheet and submitted to the Mill. Screen prints are then generated using a Mill script. One spreadsheet can be used to update and document all six of Palmetto GBA’s processing regions.

Implementing this new process resulted in a time savings of more than 75 percent, earning Holli Maner Process Improvement of the Quarter.

Up for the challenge – this team has a can-do attitude

The pre-clinician/pricing team is responsible for more complex claim locations that require more in-depth claims knowledge and research. Cumulatively, this team has more than 100 years of Medicare experience and is always quick to share information to ensure that claims are processed consistently.

This team doesn’t shy away from a challenge including taking on the workload from an additional Medicare Jurisdiction. They continually pitch in where needed, allowing the more tenured staff to assist with the clinician workload or handle other complex claims, often those with a high priority for our customers. Currently the team is helping Medical Review with their newly added clinician workload. The team assists with keying decisions and provides guidance from a claims processing perspective.

They were awarded team of the quarter for their ongoing commitment to meeting their goals and assisting in every way possible to meet customers’ needs!

Team Members:

Rhonda Blair, Julie Bricker, Elesa Fox, LaQuita Nash-Heard, Donna Lewis 

Associates of The Month for Third Quarter of 2020

July – Logan Autry

Senior Medical Reviewer Logan Autry’s willingness to help others and support her team earned her the Associate of the Month honor for July 2020. Logan often emails the team useful information and tips on navigating various programs and completing appeal reviews. If asked a question, she can be counted on to respond promptly. She never says she doesn’t know the answer and instead reaches out for help to answer the question. “Logan was extremely helpful in helping me learn how to use the new SAS® Viya® AI, analytic and data management platform. She stayed on the phone with me two different times while I navigated the system,” said Jessica Klein, Palmetto GBA Appeals Analyst.

Logan is an asset because of the help she provides completing and proofing master letters. She also reviews the Query, Design, Estimate, Contrast (QDEC) claims and is currently one of the leads for the customer service warm transfer project for Part A HHH.

August - Sabrina Holland

Sabrina Holland, a Training and Quality Assurance Coordinator, is a go-to team member in her department. She is always willing to assist with claim questions, blind second reviews, special projects, or anything asked of her. She developed instructional materials for Outpatient Prior Authorization (OPA) claims and trained three associates to handle these cases. During this project she also assisted with MACtoberfest, a Provider Outreach and Education virtual project and SAS Viya training. Sabrina not only provides educational materials for providers, but also creates individualized training materials for team members. Sabrina is known for meeting the goal of providing information in a way that is easy to understand. Her dedication to helping others understand complex subjects earned her Associate of the Month.

September - Tammie Myers

Claims II Processor Tammie Myers is dedicated to ensuring quality performance for her team. She took the lead on refresher training for claims status location making suggestions to update materials and assisting with training audits. Tammie provided virtual demonstrations of the step-by-step claims process to her team members. She also discussed her determinations for the claims process. Tammie always encourages group interaction, asks questions and is sure that everyone is comfortable with the material before moving forward. She values team feedback and asks for suggestions on how she can better present the training. Tammie’s ongoing support of her teammates to provide high-quality claims processing service earned her Associate of the Month for September 2020.