Coach of the Quarter – Cristen Boles

Cristen Boles, a Government Audit Supervisor, performed exceptionally well in the third quarter. In August, she led her team in meeting the 2017 Supplemental Security Income (SSI) deadline by completing 164 desk reviews. Cristen immediately turned her attention to the coordination of the annual wage index reviews. She worked with her team to assign all 224 units and put in additional effort to get an early start on many files. Cristen has also done an excellent job in setting interim deadlines and holding her team accountable to those deadlines. This level of organization and attention to detail will ensure the team meets and exceeds any future requests.

Team of the Quarter – RAP Penalty

A Request for Anticipated Payment (RAP) is submitted at the beginning of a billing period for Home Health Agencies (HHAs). Staying on top of RAPs and educating providers is a top priority. The RAP Penalty Team conducted fourteen webcasts between April and September of 2021, discussing proper RAP submissions. Due to this extra education, there was a 72% decrease in the claims with a Value Code QF (Late-filed Notice of Admission penalty amounts), resulting in 19 out of 20 providers having a significant decrease in their claim counts and percentage of claims with the Value Code QF.

Team Members: Makisha Callaham, Charles Canaan, and Dan George

Process Improvement of the Quarter – Appeal Paper Exhibit Documents

The JJ/JM Medicare Administrative Contractor (MAC) Appeal Position Paper process requires responding position papers to be supported by documented laws and state/federal regulations. These documents are referred to as exhibits. About 98% of the exhibits are commonly used. This process improvement entailed compiling the commonly used exhibit(s) in a central location for appeal specialists to attach to the position papers.

In 2020, there were approximately 100 appeals for JJ/JM. Before implementation, staff had to access the internet and search for valid sources to identify a document for each reference to support the position paper. At any given time, there could be two to three appeal specialists searching for the same exhibit content and selecting similar content from different sources. The process improvement resulted in one accessible folder containing content and source-verified exhibits.

Having these documents centrally located for easy access improves process quality by providing source validity and consistency of document content. Completeness and accuracy are paramount to the credibility of position papers.

July Associate of the Month: Paula Motes 

Paula Motes, a Senior Provider Education Consultant, continues to build the provider/education relationship with providers from Alabama, Georgia, and Tennessee. She pays close attention to those areas that differ between the two contracts to deliver targeted education and support for the JJ and JM providers. She collaborates with the Railroad Retirement Board (RRB) team to address Comprehensive Error Rate Testing Contractor (CERT) top errors and works with the Medical Review CERT Team lead to create ways to decrease the CERT error rate for Part B. She is also the 2021 Mactoberfest lead for Part B (Palmetto GBA’s annual symposium) and is instrumental in delivering quality education and information to our provider community.

August Associate of the Month: Taylor Barlow 

Taylor Barlow, a Cost Reporting Technician, is part of the JJ audit team who worked to finalize and complete cost reports by the end of August 2021. Taylor’s role is processing the final settlement document; one of the last steps in the process. In a short time, Taylor and his colleagues processed many final settlements. Taylor went above and beyond by working diligently and efficiently, as well as assisting others when needed to get this project completed. Taylor’s dedication and hard work in helping meet this important goal are why we are excited to announce him as Team M’s August Associate of the Month.

September Associate of the Month: Tonya Parker 

Tonya Parker, an Accounting Technician III, is consistently going above and beyond her assigned job duties. She has been instrumental in training new associates in her department. While training associates, Tonya continued to process her workload, and the team efficiently processed a large and unexpected new task. Her actions and leadership embody what it is to be Associate of the Month.