Progress | Impact

Stepping up to the plate

Jurisdiction J Award is an Incredible Honor

September 2017 brought a historic win for Palmetto GBA.

Following a more than yearlong competitive bidding process, the Centers for Medicare & Medicaid Services (CMS) selected Palmetto GBA as the Medicare Administrative Contractor for Jurisdiction J, which includes the states of Alabama, Georgia and Tennessee. Jurisdiction J represents 6.9 percent of the national Part A/Part B claim-volume workload.

The five-year contract will employ more than 460 administrative and professional employees within Palmetto GBA offices in Alabama and South Carolina. Work includes provider enrollment, outreach and education, Medicare claims processing, appeals, provider customer service, medical review, and audit and reimbursement. According to CMS, Jurisdiction J includes more than 2.5 million Medicare beneficiaries, more than 52,000 physicians and 400 hospitals that serve Medicare patients.

CMS has stringent standards for contract performance and measures execution through a variety of processes, including on-site oversight, data reviews and protocol-driven quality assurance reviews, and independent audits. Our years of delivering innovative solutions for CMS position us well to exceed their expectations and provide countless opportunities for the Palmetto GBA team to grow to new heights.

 
 

2017 Best Practice Recognition for Ethics & Compliance

Last year, Palmetto GBA was recognized with a 2017 Best Practice Award by the Health Ethics Trust for Integrating Audit and Internal Controls with Ethics and Compliance. We’re proud of the acknowledgement recognizing what our internal team already knows: Palmetto GBA’s ongoing compliance program efforts support strong internal controls.

 

 

Health Ethics Trust is a division of the Council of Ethical Organizations and works to assist healthcare organizations committed to ethical and legal conduct in coping with compliance requirements. Best practice award criteria include demonstration of:

  • Established policies and procedures
  • Detailed documentary evidence of segregation of duties
  • Ongoing associate training
  • Checks and internal verification within business units
  • Conduct risk assessments for the entire organization

Congratulations to the entire Palmetto GBA team, especially the Internal Audit Department that works diligently with the Compliance Unit to ensure compliance with applicable laws and regulations and to safeguard the effectiveness of our internal controls.

 
 
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Medicare Integrity Program

Our program safeguard activities resulted in significant savings for Medicare.

Hover over acronyms to reveal full names

JM A/B MAC

Jurisdiction M A/B Medicare Administrative Contractor

RRB

Railroad Board Specialty Medicare Administrative Contractor

BI

Benefits Integrity

n/a $1,345,749
MSP

Medicare Secondary Payer

$539,574,452 $5,812,293
MR

Medical Review

$632,935,814 $9,918,915
MR Ambulance Prior Auth

Medical Review Ambulance Prior Authorization

$12,659,670 n/a
Total $1,185,169,936 $17,076,957

$1.2 bil

2017 Medicare Program Savings

 
 

Request for Advance Payment Suppression Process

Palmetto GBA’s innovative Request for Advance Payment (RAP) suppression process continues to produce savings for the Medicare Program. In 2017, this improvement created suppression of more than 21,000 RAPs for which final claims were never submitted. Using an average RAP of $771, the RAP suppression process resulted in $16.2 million in savings for the Medicare program.

$16.2 mil

2017 savings


 

Metrics

Daily efficiencies propel near-perfect contract ratings.

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Impact

Precision & ingenuity drive uncommon results.

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Growth

Extraordinary potential through new contracts & year-over-year renewals.

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Innovations

Competitive advantage through enterprise-level innovations.

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