She will oversee medical policy develop- ment and reviews in JH and J12. CMS tasked Novitas with evaluating existing local coverage determinations (LCDs) and choosing “the most clinically appropriate” policies to be applied to the jurisdiction. Novitas turned that over to its medical directors.
“The nonphysicians among us know enough to get out of the way of that,” Mr. Vaughan said. So far, the changes are minimal, and Novitas has adopted about 75 percent of TrailBlazer’s policies, the rest from Pin- nacle Business Solutions Inc. and Caha- ba Government Benefits Administrators LLC, the other former JH MACs, Dr. Pat- terson said. Novitas did not overlay J12 policies onto JH.
“The most important thing physicians
need to do is go to Novitas’ website, pick out the LCDs that apply, study them, and go to the end of the policy to find out if it came from TrailBlazer or elsewhere. If it’s new, or there is no longer a policy for a particular service, it could affect claims processing,” she said. TMA mem- bers can find a link to the new LCDs and other key transition information at www
.texmed.org/novitas. For example, Novitas retired a Trail- Blazer policy related to drugs and bio- logics and will handle claims for cancer chemotherapy drugs differently. How- ever, experienced Novitas medical direc- tors made such coverage decisions with advice from the practicing physicians in its jurisdictions, Dr. Patterson said. In the case of the chemotherapy cov- erage, she and a Novitas medical direc- tor attended the joint American Society of Hematology/American Society of Clinical Oncology national meeting of oncology and hematology Contract Ad- visory Council (CAC) representatives in June. Novitas leadership and medical di- rectors also plan to meet with other JH oncologists, including The University of Texas M.D. Anderson Cancer Center in Houston.
Novitas will maintain current mem- bership in the CACs, groups of appointed specialists from each state who also help inform LCD policy. Other things that will not change are physicians’ access to the LCD reconsideration process and a CMS-
imposed moratorium on recovery audit contractor activities when a new MAC takes over, typically 90 days prior and subsequent to the transition date. Dr. Patterson also will oversee physi-
cian outreach and education from a Dal- las office, which was slated to open in late September. The facility will largely house Part A auditors, but also will serve as a home base for regional outreach specialists and medical directors. Novitas will have a learning curve getting to know unique aspects of Texas’ health care landscape, she says, such as the large number of physician-owned hospitals and academic medical centers. “It will take time. But one of the nice things about my being here is that we now have the benefit of the experience here, and we understand here, and we just have to make it work with Novitas,” Dr. Patterson said.
Getting ready
If physicians want to see their checks ar- rive on time, there are a few steps they must take, as well. (See “Your Imple- mentation Checklist,” page 28.) TMA staff created a website with
resources to help physicians and their office managers and administrators be- come familiar with the transition (www
.texmed.org/Novitas/). There, physicians also can link to No- vitas’ dedicated JH transition website
with details on the process, important dates, LCDs, and how to create a plan of action. TMA and Novitas recommend physicians check this website regularly for the latest updates.
TMA also is hosting webinars and a tele-town hall meeting with Novitas rep- resentatives to answer questions in ad- vance of the cutover. The TMA tele-town hall meeting will be at 8 pm CDT on Oct. 25. Novitas representatives will join TMA physician and staff experts to give phy- sicians a quick overview of what the transition means to them and to field questions. TMA will call you at your home tele- phone phone number. If you would pre- fer TMA call you at another number or if you would like to invite your office administrator or other staff member to participate, contact the TMA Knowl- edge Center at (800) 880-7955 or email
knowledge@texmed.org. TMA also will conduct a free webinar
from noon to 1 pm CDT Oct. 10 for of- fice managers and administrators. It will examine the details of what must be done before the Novitas takeover. For updates on how to register, visit www
.texmed.org/Novitas/ or contact the TMA Knowledge Center. To continue getting paid, at the top of physicians’ to-do list should be com- pleting a new electronic funds transfer
Where to get help
Here are some important email addresses, websites, and telephone numbers you should keep handy if you have ques- tions about the transition from TrailBlazer Health Enterprises to Novitas Solutions:
• Email questions to TMA at
paymentadvocacy@texmed.org. • Call TMA with questions at (800) 880-7955. • Email questions to Novitas via an online form posted at www
.novitas-solutions.com/transition/jh/ask.html. • Call Novitas at (855) 252-8782.
October 2012 TEXAS MEDICINE 27
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