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MEDICAL ECONOMICS


Too much change TMA, other societies urge CMS to keep TrailBlazer


BY KEN ORTOLON Athens family physician Douglas Curran, MD, is worried. At a time when the entire health care system is going


through huge changes — from the implementation of the Af- fordable Care Act to the rollout of the ICD-10 coding system — he doesn’t need another hassle. But that’s what he’s likely to get this summer if the U.S. Centers for Medicare & Medicaid Services (CMS) proceeds with its plans to change the Medicare administrative contractor for the region that includes Texas and six other states. “I have great anxiety about our cash flow,” Dr. Curran said of the impending switch in Medi- care contractors from TrailBlazer Health Enterprises to Highmark Medical Services, which won the contract in November. Dr. Curran, whose small group practice has a large Medicare pa- tient population, fears disruption of claims processing and payment as a result of the change in con- tractors, and he’s not alone. “Any time there is a change of this magnitude with complex sys- tems like claims payment there will be administrative hell to pay,” said Norman Chenven, MD, chief executive officer and founder of Austin Regional Clinic, a large multispecialty group. “Nothing will work for six weeks, and it will take two years to get back to ‘normal.’” Texas Medical Association officials say the potential hassles


and expense the changeover could cause physicians here and in other states are enormous. That is why TMA joined medical societies from Colorado, New Mexico, and Oklahoma to ask CMS to reconsider its decision. And TrailBlazer has formally appealed the contract award


to the General Accountability Office (GAO). GAO could reach a final decision as soon as this month.


“Any time there is a change of this magnitude with complex systems


Pushing consolidation CMS rebid the contract for both Medicare Parts A and B for Texas and six other states as part of an ongoing effort to con- solidate Medicare administrative regions from 15 to 10. The new Jurisdiction H combines the former Jurisdiction 4, which in- cludes Texas, New Mexico, Colo- rado, and Oklahoma, and Juris- diction 7, which includes Louisi- ana, Arkansas, and Mississippi. TrailBlazer is the current con-


like claims payment there will be


administrative hell to pay.”


tractor for both Medicare Parts A and B for Jurisdiction 4. Pinnacle Business Solutions is the Part A contractor for Jurisdiction 7 and the Part B contractor for Arkan- sas and Louisiana. Cahaba Gov- ernment Benefits Administrators holds the Part B contract for Mis- sissippi. Those states will have a new contractor regardless of whether Highmark or TrailBlazer ultimately wins the contract. In its November announce- ment of the new contractor, CMS said it “anticipates that imple- mentation of the new contract will go smoothly, with few, if any, disruptions in service for Medi-


care beneficiaries and providers.” The physicians in the new region, however, disagreed. In December, TMA, the Colorado Medical Society, the New Mexico Medical Society, and the Oklahoma Medical Associa- tion wrote Acting CMS Administrator Marilyn Tavenner that the decision to change contractors “is ill considered, and will cause substantial disruption when consistency and stability is needed.” TMA President C. Bruce Malone, MD, of Austin, and the


March 2012 TEXAS MEDICINE 45


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