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Does Anyone Work at Palmetto GBA?


Its Friday and I should be happy, right? They say the first five days after the weekend are the worst and here we are at day five. And yet, here I sit like a sour patch kid.

It started when a client called and asked me why the decision to remain on medical review was made by Palmetto GBA when the vast majority of their claims had been paid. I couldn’t answer but as best as I can tell based upon their letter and the meticulously kept spreadsheet maintained by the biller, only the first three claims were considered in the decision to keep my client on continued medical review. One was a LUPA.

I went to nursing school because no math was involved. That’s true. I had to take logic but no math was required. Contrary to popular opinion, it was not because I look good in white. Even to my untrained eye, I fail to see how three claims out of seventeen and don’t forget one was a LUPA is statistically significant. Please enlighten me if you can. Use small words. Dumb it down for me.

So, I called Palmetto GBA with the end result being a sudden onset of Post Traumatic Stress Disorder. I should be grateful that I survived the phone call but I’m not. Sometimes, death is more appealing than other times especially if a call to Palmetto GBA is in the future. I gather that’s part of Palmetto GBA’s grand plan and my survival instinct is too strong to let them beat me down and keep my clients’ money. Who would pay me if they aren’t paid???

I located the number on the letter on the 9 page letter from Palmetto informing my client that they had not met criteria to be removed from Medical Review. The exact sentence says:

If providers have Medicare billing and coverage questions or questions concerning this letter, contact the Provider Contact Center at 855-696-0705

Clearly I am missing something because when I read that I thought providers were being advised to call that number if they had questions about the letter. Admit it. You thought that’s what it said, too. Wrongo.

Turns out, I was answered by a government phone tree in which numerous options were offered to merely identify myself as a part A or Part B provider subdivided into states or a home health and hospice provider.

Note to Palmetto: the first two digits of a Medicare provider number identify the state where the provider is located and the third number corresponds to the type of provider calling. If providers were simply enter their provider number, it would be a lot faster assuming your employees knew how to decode provider numbers. Big ‘if’. I know.

After I arrived at the home health and hospice branch of the phone tree, I was given six options. None were, ‘ask a real person a question’. I would have settled for, ‘if your reason for calling is something else, please press 0’. No such luck. I listened to the recording all the way through 3 times. There is no access to human beings at Palmetto GBA who can speak intelligently about Medical Review in the menu (listen carefully because it has changed). That’s a fact, Jack.

Out of desperation, I hit zero, which was not an option, and Hark! It worked. I got the person with the absolute worst job at Palmetto – the initial phone answerer. She was actually quite competent inside her job description fueled by paranoia from individuals who are afraid to answer questions about the policies at Palmetto GBA.

It took her three goes to get my question correct. Could have been my fault; I don’t know. All I wanted to know is why were only three of seventeen claims considered in the decision that forced my client to undertake the expense and interruptions to patient care that define Medical Review. That’s all.

After we worked diligently together to get the message just right, I was very politely placed on hold. When the phone person returned, she was pleased to tell me that my message had gone through and someone would return my call in seven to ten days.

THIS IS NOT A SEVEN TO TEN DAY PROBLEM, FOLKS.

I explained that to her. I asked to be transferred to Medical Review. They do not have telephones, it seems. I asked for an email address. They do not email, either. They just sit in their corner and deny, deny, deny and are conveniently unavailable to answer any questions. They are not paid to answer questions and they are definitely not paid to be statistically or otherwise relevant.

I decided to play hardball and asked for the director of Medical Review. They don’t have one. Imagine that. I explained that the policies she adhered to in order to maintain employment sucked. I told her I merely wanted the name of someone who had the authority to make decisions.  She said that information was not available.

My therapist said to journal my thoughts and feelings and perhaps the healing process would begin. Bring on the healing process.

Should my healing process not be forthcoming, please share with me the name of the Directors of Medical Review if you happen to know them. And during your next survey, explain that your administrator is paranoid and will not divulge his or her name for the Disclosure of Ownership. See how far that gets you.

I must admit that I am feeling nostalgic for the days when Regina Zaucher’s phone number and extension were available for the dialing. I miss the intelligent people who want to help honest providers. I may be getting old but I am not a tree hugger and I do not like their phone trees and the way they have been pruned to eliminate any meaningful personal contact.

I know airing my concerns all over the internet may not be the classiest thing I’ve ever done but I assure you that I have done far worse.  Let me ask you.  What am I supposed to do when the people who are able to answer questions and provide assistance to providers are unreachable?  How else do I get through?

Please feel free to forward the link if you happen to know someone who works at Palmetto GBA. If you work at Palmetto, please feel free to comment.  I speak for us all when I say that we would love to hear from you.

2 Comments Post a comment
  1. Susan #

    I had the exact same experience Thursday. I had sent in 72 Adrs between Jan 1 and March 31. 80% paid however only those that paid/denied by March 31 counted in the CDR which was the 17 I sent in January that weren’t reviewed and paid/denied until March 31! And now I get the results 6 weeks into another quarter and if history repeats itself none will get processed by June 30 so I will have a 100% CRD and be writing a POC!

    Like

    May 17, 2015
    • This is a problem and we have no recourse.

      The client in this email had all that paid and denied BEFORE Feb 1 counted.

      I heard from a hospice client that uploading the ADRs electronically generally results in a faster turn around time but I contend that they should count all of the ADRs. I remember when there would occasionally be a gap between review quarters because results weren’t calculated. They are too much in a hurry to deny claims.

      Like

      May 17, 2015

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