A message from Joe

High-level performance and innovative solutions are foundational to Palmetto GBA. They drive our robust 58-year history and make us highly competitive and a better partner.

Yet, it’s knowing the work we do matters to so many people that drives our resolve. Every day, we help people, we solve problems, we go the extra mile. It’s these very points of impact that propel us forward.

In affirmation to the continued good work of the Palmetto GBA team, I’m proud of winning the Pricing, Data Analysis, and Coding (PDAC) contract again last year. Through this vehicle, we support the Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), CMS, federal law enforcement agencies, and National Provider Enrollment (NPE) East and West.

We’re pleased 2023 saw us positioned to continue supporting CMS learning and training initiatives. In addition to our Medicare Learning Network contract, we’ll be supporting Highpoint Digital Inc. under a new CMS Contact Center Training and Content contract to develop and maintain training and content solutions for CMS contact center operations customer service representatives.

Palmetto GBA has a strong history of innovative pilot projects with CMS, and in 2023 we moved two programs forward. Under the Jurisdiction J A/B MAC contract, the Clinical Language Intelligence (CLI) Pilot to Support Medical Review proof of concept was launched. We also implemented a new Review Choice Demonstration (RCD) Program for Inpatient Rehabilitation Facility (IRF) Services.

We believe just as deeply in advancing our local communities by giving back to our neighbors. In 2023, we donated more than $323,000 to the United Way and focused our company-wide initiative on children’s advocacy. Specifically, we partnered with Healthy Learners, an organization eliminating health barriers that hinder children from succeeding in school, with volunteer hours, monetary donations and much-needed items.

While no year is without its unique challenges, I’m proud of what the Palmetto GBA team achieved in 2023 and our ongoing tenacity. We are positioned to move forward with confidence and purpose, as we pursue new opportunities, face new challenges, and renew our commitment to supporting the communities we call home.

Regards,

Walter J Johnson Signature

Walter J Johnson

President & COO

Our Philosophy

We believe technical and administrative solutions have the power to enhance service and quality. And that they play a major role in the healthcare of our country’s elderly population. We constantly strive to reach new performance heights and improve the quality of life for our customers, employees and communities.

2023 Scale

$66.8

billion

Benefits Paid

11.0

Million

Beneficiaries Served

165.4

Million

Claims Processed

1.1

Million

Inquiries Answered

medicare integrity program results

  Jurisdiction M A/B Medicare Administrative Contractor Jurisdiction J A/B Medicare Administrative Contractor Railroad Board Specialty Medicare Administrative Contractor
Benefit Integrity N/A N/A $2,516,730
Medicare Secondary Payer $592,357,929 $502,467,043 $5,737,205
Medical Review $521,566,966 $624,585,643 $6,142,022
Medical Review Ambulance Prior Authorization $879,249 $1,683,713 $202,241
Medical Review Outpatient Prior Authorization $21,855,362 $20,752,722 N/A
Total $1,136,659,506 $1,149,489,121 $14,598,198

Jurisdiction M A/B Medicare Administrative Contractor

Benefit Integrity:

N/A

Medicare Secondary Payer:

$592,357,929

Medical Review:

$521,566,966

Medical Review Ambulance Prior Authorization:

$879,249

Medical Review Outpatient Prior Authorization:

$21,855,362

Total

$1,136,659,506

Jurisdiction J A/B Medicare Administrative Contractor

Benefit Integrity:

N/A

Medicare Secondary Payer:

$502,467,043

Medical Review:

$624,585,643

Medical Review Ambulance Prior Authorization:

$1,683,713

Medical Review Outpatient Prior Authorization:

$20,752,722

Total

$1,149,489,121

Railroad Board Specialty Medicare Administrative Contractor

Benefit Integrity:

$2,516,730

Medicare Secondary Payer:

$5,737,205

Medical Review:

$6,142,022

Medical Review Ambulance Prior Authorization:

$202,241

Medical Review Outpatient Prior Authorization:

N/A

Total

$14,598,198

$2.3

billion

2023 Medicare Program Safeguard Savings

2023 Highlights

Inpatient Rehabilitation Facility RCD

Safeguarding Medicare from fraud and abuse

INNOVATION

Molecular Diagnostic Testing – MolDX

Evaluating and establishing coverage reimbursement

STANDARDIZATION

Clinical Language Intelligence Pilot Project

Reducing denials and speeding claims payments

ADVANCEMENT

Fee-for-Service Contract Maps

2023 service across the U.S.

PROGRESS

CAQH CORE Certification

Gold standard recognition

HEADWAY

Community Impact

Giving, helping, serving in 2023

PHILANTHROPY
Leadership Board of Directors 2023 Financials
Palmetto GBA

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Palmetto GBA is a leading provider of high-volume claims and transaction processing, contact center operations and technology services to the federal government. Our core business is to provide support to the Centers for Medicare & Medicaid Services (CMS), Medicare beneficiaries and Medicare providers.