Client Services > Innovations
|
“Ingenuity is in Palmetto GBA’s DNA. We constantly seek opportunities to be more efficient, reduce costs and increase quality for our customers.” Nella BishopCIO & Vice President - Systems & Support |
|
“Ingenuity is in Palmetto GBA’s DNA. We constantly seek opportunities to be more efficient, reduce costs and increase quality for our customers.” Nella BishopCIO & Vice President - Systems & Support |
Kavita Chada - Medicare Programming Analyst | Jasmine Keller - EDI Operations I Associate
Creating value our customers can depend on year after year.
eServices Roster Billing Module
The COVID-19 Public Health Emergency drove a significant increase in roster bill submissions for mass immunizers and Medicare Part B providers. In a proactive step to support them, Palmetto GBA’s Part B/Railroad Retirement Board SMAC Operations Support, eCommerce and Provider Outreach and Education teams collaborated to develop a user-friendly, intuitive and efficient method for these billers to quickly submit their immunization rosters via the Palmetto GBA eServices Portal.
The teams successfully developed and deployed a tool to provide billers a seamless submission process for up to 50 patients at one time. The customized template is easy to complete and upload, and it accommodates COVID-19 immunizations, Monoclonal Antibody infusions, Influenza and Pneumococcal immunizations.
up to | 50 |
patient submissions
at a time
Provider benefits of the eServices Roster Billing Module include:
Near real-time status updates for roster billers
An always current roster worksheet for billers, reflecting the most updated CMS codes available for reimbursement
Quality check for billers to verify roster billing information prior to final submission
Ability to track the roster status as it processes
Optic Pilot Project
Palmetto GBA conducted a pilot project utilizing Cedar Care Inc.’s Electronic Health Records (EHR) interface, Optic, to support our Outpatient Hospital Department Prior Authorization program. The purpose of this pilot was to reduce the amount of manual work required of healthcare staff to obtain prior authorization for certain procedures, imaging and labs done in hospital settings.
With Optic, Palmetto GBA’s nurses can view relevant parts of the medical record for a Medicare beneficiary directly from the provider’s EHR system. The ability to view the records eliminates the need for the provider to manually submit the medical records to Palmetto GBA for prior authorization review. This is a significant benefit to the healthcare organization, as staff are more available for other critical needs. In addition, Optic decreases the time needed to submit a prior authorization request and allows for faster prior authorization decisions. Early results include reduction in errors, manual work, and decision turnaround time.
National Supplier Clearinghouse (NSC) Site Visit Review
Artificial Intelligence (AI)/Machine Learning (ML)
Under the current National Supplier Clearinghouse (NSC) MAC contract, we receive inspections from site visit contractors. Within 30 days, we’re required to review each completed site visit form and determine if the Durable Medical Equipment (DME) supplier passed or failed their site visit. The volume of manual review makes this process viable for Artificial Intelligence (AI), primarily to reduce review time, identify problematic suppliers earlier, and decrease the possibility of manual review error.
In spring 2021, working with Guidehouse, we trained 250 Machine Learning (ML) models to predict whether a site visit is classified as a pass or a fail. Our top ML models were approximately 99% accurate in predicting a pass or fail. Equally as successful, the ML models processed 3,000 site visit forms in mere seconds.
99%
accuracy in predicting a pass or fail
By fall 2021 we took the program live. Now, once a physical in-person site visit form is uploaded, it automatically attains a pass or fail prediction. As of the end of November, our ML models were producing approximately 1,000 pass or fail predictions per month.
