To continue getting paid, at the top of physicians’ to-do list should be completing a new electronic funds transfer agreement for those already enrolled in the program.
service Part A and Part B claims — close to the 26 percent maximum CMS sets for any one contractor. Jurisdiction H repre- sents approximately 13.2 percent of na- tional Medicare claims volume, includ- ing 147,000 physicians and other health care professionals, and 1,300 Medicare hospitals.
The jump in workload raised physi- cians’ eyebrows. TMA’s Payment Advocacy staff mem-
bers are closely monitoring the transi- tion and remain in regular conversations with Novitas to prepare physicians for the change. “We have had a professional experi- ence thus far, and we hope to continue to develop a relationship that enables the association to address issues as they arise,” said Lee Spangler, JD, TMA’s vice president for medical economics. CMS also has to do its part, he added.
Louisiana, Mississippi, New Mexico, and Oklahoma. But the agency does not have to wait the full five years to let the con- tractor go if it does not live up to its end of the bargain. “We want to be a good partner and communicate effectively and build rela- tionships. We are not going to disappear from the landscape once we get to the cutover,” Mr. Vaughan said.
Novitas who? Novitas is the product of transition, as well, albeit in the health insurance plan market.
The company was formerly Highmark
Medicare Services Inc. (HMS), which won the CMS contract for MAC JH on Nov. 8, 2011. Pennsylvania-based health plan Highmark Inc. later sold HMS to a holding company owned by Blue Cross Blue Shield of Florida Inc. The deal, and the name change, closed in January. Novitas now administers Part A and
Part B claims for Jurisdiction 12 (J12), which includes Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia.
The carrier landed in Texas after
CMS rebid the contract for JH, which combines former Jurisdictions 4 and 7
26 TEXAS MEDICINE October 2012
under a broader strategy to consolidate Medicare administrative regions from 15 to 10 by 2016. TrailBlazer, which was the MAC for
Texas, Colorado, New Mexico, and Okla- homa for decades, appealed the contract award. The Texas Medical Association, the Colorado Medical Society, the New Mexico Medical Society, and the Okla- homa Medical Association supported the appeal. However, the U.S. Government Accountability Office denied the appeal in March. TrailBlazer will continue to process claims through Nov. 16, a Friday. Novi- tas will begin receiving electronic claims that evening.
Come morning on Monday, Nov. 19, Novitas will begin full operations and double its workload; in other words, process twice as many claims as it did when it handled only J12. The contact center opens Nov. 20, when Novitas gains access to the CMS databases need- ed to respond to inquiries. The company also will process Indian Health Services facility claims for the entire country and support centralized billing by immuniza- tion clinics.
In all, Novitas will handle roughly 25 percent of national Medicare fee-for-
“We continue to encourage CMS to oversee its contractor during the transi- tion, and we are always going to hold CMS accountable for its decision. There are going to be wrinkles, and we want to make sure CMS is on top of things. And we hope Novitas through its experience with other states has learned to avoid those wrinkles,” Mr. Spangler said.
Ramping up Mr. Vaughan acknowledged the extent of the undertaking, but said the carrier is ramping up. Highmark’s experience with the J12 consolidation, which also represented a doubling of claims vol- ume when it took over in 2007, paved the way. “We’ve been through this before: the mechanics of setting it up, making sure we answer phones on day one, and that the first payment cycle processes. It is huge, but there’s also a certain predict- ability to it,” Mr. Vaughan said, noting that many of the systems are even more standardized than in earlier transitions. Novitas continues to recruit special-
ists from TrailBlazer to capitalize on their familiarity with the region. For example, the company hired Trail-
Blazer’s former contractor medical direc- tor for Texas, internist Debra Patterson, MD, as Novitas’ vice president of clinical affairs and executive medical director.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68