“We’re not saying TrailBlazer is perfect, but we have every right to be concerned, not just with the details of the transition and the problems it will cause but also with whether the customer service will be there.”
gan. That means every physician and other health care professional in the four states will have to execute new electron- ic funds transfer agreements with High- mark’s bank before they can get paid. Also, the societies said Highmark uses
a different “front end” claims-processing system than TrailBlazer. That will require physicians to test their practice manage- ment software to ensure it’s compatible with Highmark before they can conduct electronic transactions. The medical society presidents said these activities would be an added bur- den for physicians who already have to test their practice management systems to make sure they are compatible with the new 5010 transaction standards im- plemented under the Health Insurance Portability and Accountability Act. “Again, this will introduce delays in claims payment and increase costs in physician practices,” they wrote. Lee Spangler, JD, TMA’s vice presi-
presidents of the three other state soci- eties signed the letter. The four states made up the former Jurisdiction 4. In the letter, the medical groups raised concerns that Highmark — which already is the contractor for a Medicare region that includes Washington, D.C, Philadelphia, and several other large cities — could not achieve cost savings called for under the contract and may have underestimated the number of ad- ditional staff it needs to handle claims from the region.
Highmark plans to add 500 new em- ployees to process the additional claims volume, but even Highmark President
Patrick Kiley raised doubts about the company’s ability to deal with the work- load when he said the company’s total fee-for-service claim volume would be “close to the maximum any one company can handle.”
“The medical societies believe it is
very possible that award of this contract to Highmark exceeds its ability to handle the workload, and respectfully urge the GAO and CMS to review Highmark’s ac- tual capabilities,” the society presidents wrote.
That’s what has Dr. Curran, a mem- ber of TMA’s Board of Trustees, worried. Medicare patients make up 35 percent to 45 percent of his practice. So any disrup- tion in processing his Medicare claims could mean serious cash flow problems for his practice.
Douglas Curran, MD
Norman Chenven, MD
46 TEXAS MEDICINE March 2012
Piling on hassles In addition, the medical societies raised concerns about three other issues that will cause significant hassles and ex- pense for physicians. First, Highmark currently uses US Bank to pay Medicare claims while TrailBlazer uses JP Mor-
dent for medical economics, say physi- cians may face the expense of testing their practice management systems and may have to adjust them to work with Highmark’s payment system “front end.” Dr. Curran says that could be a sig- nificant expense for his 11-physician practice. Finally, if Highmark gets the contract, it will have to review all of TrailBlazer’s local coverage determination policies and likely would issue many new cov- erage decisions. Under a local coverage determination, a contractor decides whether it will cover particular services on a carrier-wide basis. Mr. Spangler says that likely will cause considerable confusion about what services are covered while physicians sort out those changing policies.
Timing is everything Mr. Spangler and Colorado Medical So- ciety Chief Executive Officer Alfred Gil- christ say changing Medicare contractors now is just a matter of bad timing. “Given the fact that doctors are try- ing to build out medical homes, install health information technology, deal with the new world of care coordination and transparency, and certainly with ICD-10 coming on and all that will entail, we
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