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“As problems surfaced, TMA stepped in to mitigate them, and Novitas responded.”


tional issues that affected all Medicare contractors.


“In sheer numbers, those [alerts] are not indicative of our typical performance, and it’s something that will not persist,” Mr. Vaughan said. Nor did they affect a large swath of providers or claims. But those and other factors contribut- ed to higher-than-expected call volumes that caught the company off guard and impacted customer service quality. Ques- tions related to a new national policy that took effect just before the transition also consumed 20 percent of the call center’s capacity. “The notable area where we have fall-


cated folks on what they needed to do and what we needed to make that hap- pen and overall, while there were pock- ets of physicians with unique situations, we think implementation was a success,” she said. “Whatever problems there are, we will continue to be transparent. Was it rough the first few months? Absolutely. Have we turned the corner? Absolutely.” TMA’s Payment Advocacy staff mem- bers continue to closely monitor Novitas’ operations. They remain in regular con- versations with the carrier and the Cen- ters for Medicare & Medicaid Services (CMS), which approved Novitas as the regional Medicare contractor in 2011. For the most part, payments were not disrupted, says Lee Spangler, JD, TMA vice president for medical economics. “As problems surfaced, TMA stepped in to mitigate them, and Novitas re- sponded,” he said. “To expect a transi- tion of this scale to happen without issue is unrealistic. There will continue to be challenges as the transition progresses, and Novitas has been open to address- ing issues that we have brought to their attention.”


Falling short Novitas landed in Texas after CMS re- bid the contract for Jurisdiction H (JH), which includes Texas, Arkansas, Colora- do, Louisiana, Mississippi, New Mexico, and Oklahoma. The company, formerly


46 TEXAS MEDICINE April 2013


Pennsylvania-based Highmark Medicare Services Inc., took over from TrailBlazer on Nov. 19, 2012. Novitas also administers Part A and


Part B claims for Jurisdiction (J12), which includes Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia. Novitas representatives say some of the issues physicians experienced post- transition are typical as a new carrier gets settled, for example, assimilating an outgoing contractor’s records and fine- tuning edits of old TrailBlazer policies. In the big picture, the company was


able to keep payments stable, and any is- sues were “relatively small in impact and short-lived,” said David Vaughan, vice president and transition manager. On the other hand, unique issues like the mismatch in records Drs. Mohiuddin and Abreu experienced are not indicative of a wholesale problem, but if it’s still occur- ring, “we want to know.” However, one look at the Novitas


website revealed what Mr. Vaughan ac- knowledged was an inordinate number of “system alerts,” notifications relating to incorrect claims denials, long call wait times, and new enrollment delays — all areas the company has targeted for im- provement.


The majority of the alerts, including


incorrect denials, stemmed from policy edits during transition, others from na-


en short is in the Contact Center. Right- fully so, providers have cited customer service components most often as a source of frustration. But this is also the same area that has shown remarkable improvement as measured by shorter wait times and fewer busy signals,” Mr. Vaughan said.


Novitas continues to increase staff and training to adjust and improve quality so agents don’t have to bounce doctors around to various departments. The company also plans to enhance its website to make it more user-friendly. For example, a new status inquiry tool is now available for physicians to check their enrollment applications. Before CMS approved the transition, TMA and other state medical societies expressed concern that Novitas would be taking twice as many claims as it handled when it serviced only J12. Mr. Vaughan says the increased work- load has not been an issue. However, an unprecedented surge in appeals has been a problem that has af- fected service and processing timeliness. Most of those appeals carried over from TrailBlazer, but the trend has continued with new appeals, perhaps because prac- tices held on to them knowing the transi- tion was at hand, he says. For Austin orthopedist and past TMA


President C. Bruce Malone, MD, that meant months of delay while his prac- tice awaited resolution on $6,000 in ap- peals left pending with TrailBlazer. His insurance coordinator, Jackie


Brown, did her part to follow the rules, research each individual appeal, and


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