(EFT) agreement for those already en- rolled in the program.
The form authorizes Novitas’ bank, U.S. Bank, to directly transmit payments to physicians in place of TrailBlazer. CMS in late July sent letters to physi- cians outlining the requirement. A copy is online at
www.texmed.org/Novitas. Physicians will need to mail paper
claims to a new address. And TMA staff recommends that physicians who may need to enroll in Medicare or make changes to their current Medicare enroll- ment complete their enrollments online to avoid the potential for lost paperwork during the switch.
Informing practice managers, admin- istrators, and third-party vendors — any- one involved in the billing process — of the impending changes also is key.
So far so good? Arkansas and Louisiana were the first in JH to undergo the Novitas transition in mid- to late August. At press time, no major problems had surfaced, according to medical and hospital associations in those states. “We had no major blow-ups in the first few days, but we haven’t had a signifi- cant enough operational time frame to make a judgment,” said Kevin Bridwell, Louisiana Hospital Association vice president of health care reimbursement. “Novitas has done a decent job of com- munication, and that speaks well of the job they’ve done so far on the front end. But that changes tomorrow if claims don’t get paid. That’s where the rubber meets the road.” CMS regional office officials reported that Novitas experienced “some delays”
in receiving Part B claims on its first day of operations in Arkansas and Louisiana, Aug. 14. Since then, all claims receipts and payments have occurred without interruption, and “workload processing indicators appear normal.”
The issue affected few physicians and did not involve any flaws in the elec- tronic claims-processing system (EDI) itself, Mr. Vaughan says. As a precaution, Novitas temporarily disabled the system, fixed the affected files in a few hours, and notified physicians when it was up and running.
Your implementation checklist
The Nov. 19 deadline for the transition to Novitas Solutions Inc. as the new Medicare contractor for Texas is around the corner. Here are some steps physicians and practice managers can take to get ready and get paid.
• Check the Novitas JH transition website frequently (www
.novitas-solutions.com/transition/jh/index.html) and sign up for the email list for Segment 5 (TrailBlazer Part B, Texas, Colorado, New Mexico, and Oklahoma).
• Submit the electronic funds transfer (EFT) agreement, CMS Form 588 (
www.texmed.org/Novitas/).
• Change post office box addresses for paper claims. • Check new local coverage determinations. • Notify relevant office staff and third parties — practice man- agers, electronic billing systems clearinghouse (EDI), soft- ware vendors — and create a comprehensive action plan
• Perform EDI testing before the cutover. • Note new telephone numbers and call flow for claims and eligibility status, payment information, EDI assistance, and medical policy departments.
28 TEXAS MEDICINE October 2012
CMS officials said Novitas must meet the same “stringent” standards as any other MAC, which include “myriad” per- formance and service level metrics — more than 200 according to Mr. Vaughan — for various functions, such as claim processing, appeals adjudication, and overpayment collections. That means, for example, making sure physicians do not get a busy signal when they call, an- swering calls speedily, and processing a minimum of 95 percent of clean claims — those that contain all the necessary in- formation — within 30 days. In addition, Novitas is subject to
hourly, daily, and weekly monitoring and must submit regular reports to CMS at various points during the transition. “CMS is very sensitive to the disrup- tions that MAC operations may have upon providers and their ability to afford beneficiaries with access to care,” region- al officials said. “We have developed de- tailed oversight plans that help us plan for contingencies and detect anomalies quickly so as to ensure that transitions occur as seamlessly as possible.” The agency said it did consider No- vitas’ workload in the contract award decision and found the company passed muster: In calendar year 2011, Novitas processed 103 million Part B claims in J12, with 99.55 percent of clean claims processed within 30 days. TrailBlazer had similar performance numbers. CMS has miscalculated before, how-
ever. A 2010 GAO report highlighted obstacles in the early MAC transitions elsewhere in the country, including CMS’ underestimation of pending appeals cas- es and telephone calls that resulted in service issues for the incoming MACs.
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