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MEDICAL ECONOMICS


Turning the corner Novitas gets a rough start


BY AMY LYNN SORREL The ordeal was scary enough when last April, Imran Mohiuddin, MD, learned TrailBlazer Enterprises, Texas’ Medicare carrier at the time, began recouping money because its records erroneously showed he did not participate in Medicare. In fact, the Sugarland vascular surgeon had the same Medicare ID for at least three years. Fortunately, TrailBlazer corrected the mistake within a few weeks and promptly reimbursed Dr. Mohiuddin with no lapse in coverage.


So it came as a surprise when the physician found himself in the same scenario not long after Novitas Solutions Inc. took over from TrailBlazer last November — only this time the con- sequences were much direr. Without notice, Novitas began recouping money from Dr. Mohiuddin — more than $40,000 be- tween December and February — for what turned out to be the same error. Because nearly two years had lapsed from when the error first occurred, however, the supposed amount he owed was up to $600,000 in Medicare overpayments. Dr. Mohiuddin didn’t find all of this out until he noticed that the Treasury Department had placed a tax withhold on his Medicare bills until he repaid the money.


He and his staff started an ava- lanche of calls to Novitas. But be- tween the long wait times and various representatives who appeared unaware of and unprepared to handle the issue, “we weren’t getting anywhere,” he said. During the two months it took Novitas to sort things out, the payment holds took a toll. His practice made plans to shut down. Dr. Mohiuddin dipped into a line of credit to avoid that, but has since foregone his own salary to keep the practice afloat.


“I understand things can happen with any change. But even small mistakes are affecting people’s lives, and there has got to be better communication,” he said. “I’m not doing elective surgery. All my patients are very sick. What would happen to them if the practice closed? To my employees?”


After Dr. Mohiuddin used the Texas Medical Association’s “Our No. 1


goal was to not interrupt cash flow.”


Hassle Factor Log to enlist help from the Payment Advocacy Department, and got a lawyer, Novitas stopped holding back payments and is on its way to reimbursing the surgeon. Apparently when Novitas took over TrailBlazer’s records, the transfer did not reflect the earlier resolution of the matter. The same issue nearly cost Ricardo Abreu, MD, $80,000 — twice. The Weslaco pulmonologist returned the overpayment under TrailBlazer when the region he practices in no longer qualified as an underserved area eligible for Medicare bonus payments. Yet Novitas claimed the money again last December, also without notice. For two months, Dr. Abreu and his staff called day after day with little response, during which time the doc- tor also collected no salary so he could pay his employees. Again, it wasn’t until TMA’s Pay- ment Advocacy Department inter- vened that his case sped along and he finally was paid. “We knew there was going to be


a transition,” Dr. Abreu said. But it was the lack of notice and urgency in investigating the matter before pe- nalizing him that made the scenario “very stressful.”


The issue was just one among a number that physicians endured dur- ing the switch — some of them costly and others just plain frustrating. De-


spite the variety of problems, one theme persists. “There are practices that rely on payment from Medicare.


They [Novitas] have to communicate better with physicians,” Dr. Abreu said.


Novitas Chief Executive Officer Sandy Coston acknowl- edges the company fell short in some areas, with customer service challenges and delays in appeals processing being the main ones.


But now that the transition is ending, and Novitas is well on its way to fully implementing its own policies and proce- dures, Ms. Coston says the ride will be smoother. “Our No. 1 goal was to not interrupt cash flow. We edu-


April 2013 TEXAS MEDICINE 45


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