MEDICAL ECONOMICS
Rebuilding relationships Physicians prepare to switch from TrailBlazer to Novitas
BY AMY LYNN SORRE L There’s a new MAC in town, and Texas physicians are waiting to get a glimpse of just what the carrier is made of.
On Nov. 19, the Centers for Medicare & Medicaid Services (CMS) will flip a switch, and Novitas Solu- tions Inc. will take over from TrailBlazer Enterprises as the new Medicare admin- istrative contractor (MAC) in Texas and other states. As they brace for the glitches that can come with any big change, physicians want to ensure they are not left in the dark.
Doctors have some im-
portant administrative du- ties to prepare their prac- tices for the cutover. But the bulk of the responsibility for a smooth transition rests in Novitas’ corner.
“It’s a huge task for Novi- tas to bring in people who don’t know this area and to set up a completely new system without any hic- cups. The biggest problem I see is rebuilding the kind of strong relationships we had with TrailBlazer’s medical directors, policy nurses, and the people that actually help us file claims and get answers quickly,” said Garland ophthalmologist John M. Haley, MD. “It’s a different ballgame now, and it takes a long time to develop trust with a new carrier. And that’s what it takes for this to run smoothly — trust.”
Physicians with a large Medicare patient population like Garland ophthalmologist John M. Haley, MD, have a lot riding on a smooth transition to a new Medicare contractor.
With Medicare patients making up 60 percent to 70 percent of his practice, Dr. Haley is “totally de- pendent” on a fluid shift. Adjusting to new names, phone numbers, forms, and codes are one thing, and no small hassle at that. But missing a check is not something he can afford.
That’s why avoiding payment disruptions is a top priority, said David Vaughan, Novitas vice president and project manager for the upcom- ing transition. “Job No. 1 for the tran- sition and beyond is to preserve cash flow, and really closely aligned with that objective is to make this the least dis- ruptive as possible and minimize changes on the provider community,” he said. “To the extent we have fewer moving pieces, the less likely things will go wrong. We’ve done a lot of due diligence and
worked with TrailBlazer since the onset, and we are using those differences to fuel our education efforts and make im- provements where necessary.” The stakes are high for the contractor, too, to perform well,
Mr. Vaughan added. Novitas has a five-year contract with CMS for Part A and Part B fee-for-service claims in Medicare’s new Jurisdiction H (JH), which includes Texas, Arkansas, Colorado,
October 2012 TEXAS MEDICINE 25
BRETT BUCHANAN
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