Client Services | Innovations
Ingenuity is foundational.
Cloud Hosting Activity
Palmetto GBA was awarded a pilot project task order to determine how Medicare Administrative Contractor (MAC) security controls can be implemented in the Centers for Medicare & Medicaid Services (CMS) Amazon Web Services (AWS) Private Cloud. The goal: determine and document the requirements of moving MAC applications to the cloud and how CMS will implement the 393 security controls required by the MAC contracts and the Federal Information Security Modernization Act (FISMA) High environment. We completed Phase II of the pilot December 2022, highlighting options for CMS related to Cloud utilization and security requirements, especially around the A/B MAC contracts.
Ours is a culture built on strong customer service. Really, it’s our number one priority. We’re committed to finding resolutions for our customers and going above and beyond.”
Robin Key
Manager, Customer Service
Computer Assisted Review of Documentation (CARD)
In partnership with MCG Health LLC (MCG), we continued development, implementation and operation of our pilot project supporting the Home Health (HH) Review Choices Demonstration (RCD). In this we use Outcome and Assessment Information Set (OASIS) data to adjudicate pre-claim review (PCR) requests. Home health data elements from the OASIS submissions are mapped to the MCG Cite™ AutoAuth Module, driving an automated determination of compliance or inability to determine compliance. Much of 2021 and 2022 was spent developing this solution, where automation allows large data sets to be tested to further validate accuracy, specificity and sensitivity.
The HH RCD continues to provide significant savings to CMS. Palmetto GBA has completed nearly 4.8 million PCR requests and pre- and post-payment reviews since June 2019. This demonstration is active in five of the 16 HH states within the Jurisdiction M A/B MAC contract. Based on successes to date, CMS intends to expand to the remaining 11 states within the contract. Further expansion is dependent on lifting of the Public Health Emergency (PHE).
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PCR requests and pre- and post-payment reviews completed since 2019
Optum Product Development
Last year we continued development of a Molecular Diagnostic Coding and Coverage (MDCC) product. We licensed the Z-Codes™ and DEX™ platform for registering and coding of molecular tests to Optum, as well as performed and developed molecular test clinical assessments to develop a comprehensive product offering.
We completed Phase II rollout of the Medicare Advantage program for United Healthcare. This means all Medicare claims for in-network providers require Z-Codes and can be adjudicated based on the technical assessments performed by Palmetto GBA.
Also, Palmetto GBA and Optum have worked with Avalon Healthcare Solutions to incorporate these processes and procedures into their commercial health plan offerings. The commercial product will be deployed first with United Healthcare, with an expected effective date of June 1, 2023. However, technology deployment and technical assessments will begin as early as spring 2023. The commercial rollout will also be conducted in phases similar to the Medicare Advantage solution.
We’ve begun creating procedures for assessing these tests, and feedback from our partners has been extremely positive. Other large private payors have expressed interest in the Optum product.
Customer Experience (eChat)
Our Customer Experience program continues to focus on ensuring our customers have positive interactions with Palmetto GBA. Forging great relationships and providing exceptional service is what sets us apart from our competitors. In June of last year, we launched a pilot in our Jurisdiction J A/B MAC to increase chat usage for our providers. The pilot has been extremely successful, achieving a 4.5 customer satisfaction rating in December on a 5.0 scale. We hope to expand the pilot to our Jurisdiction M A/B MAC in 2023.
Also, acting on our customers’ feedback we implemented a new search engine on our corporate website to help our providers find information faster and easier than before.
