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December with average answer time lon- ger than 10 minutes and call completion rates of 50 percent. As of late February, those figures im-


proved dramatically, and Novitas is on track to meet CMS performance stan- dards regarding the call center and time- ly appeals processing by spring, regional officials say.


They added that they are “in agree-


ment” with the carrier’s review strategy regarding high-level E&M codes. CMS staff actively monitor the carrier


through regular meetings, reports, and site visits, and “when necessary and ap- propriate, intervene to ensure a specific provider’s concern is resolved to the ex- tent allowed by law and any applicable regulations,” regional officials said. Indeed, the transition for the JH re- gion was the largest CMS has overseen. The agency acknowledges that it had


underestimated the appeals workload — an issue that came up in earlier transi- tions, according to a 2010 Government Accountability Office report.


CMS said it was limited by the histori- cal data it had to go on, and estimating workloads for transitions is an activity it constantly refines. As for Novitas, “to be sure, there is a learning curve in some very visible functional areas such as their Provider Contact Center, but transitioning work from one [Medicare carrier] to another is a very complex undertaking, and no transition has gone without some degree of complications,” CMS regional officials said. “The critical part is how quickly and accurately a contractor responds to issues as they arise. From our perspec- tive, Novitas has done a relatively good job managing all the transition issues that have surfaced.”


Availity to stop free Medicare, Medicaid claims submission


TMA Hassle Factor Log to the rescue


Physician members got help with their Novitas issues by using the TMA Payment Advocacy Department’s Hassle Factor Log. The program helps doctors bring their insurance-related issues to TMA’s attention so staff can investigate problems and work with private health plans, Medicaid, and Medicare to get claims paid correctly. The Payment Advocacy Department’s work has paid off over


the years. In 2012 alone, the department helped TMA members recover nearly $50 million. Physicians can use the Hassle Factor Log to document their dispute, the type of payer they are dealing with, and the reasonable attempts they have made to resolve claim issues, including the appeals process. Download the Hassle Factor Log and learn more about the


program at www.texmed.org/hassle, or email the TMA Payment Advocacy staff for assistance at paymentadvocacy@texmed


.org. You also can contact the TMA Knowledge Center at (800) 880-7955.


48 TEXAS MEDICINE April 2013


Beginning June 1, Texas physician prac- tices using the claims clearinghouse Availity can no longer electronically sub- mit their Medicare and Medicaid claims through the exchange for free. The health information technology company plans to discontinue the free service for the government claims and for health plans that do not subsidize the costs. To give doctors time to find alterna- tives and avoid payment disruptions, however, Availity will phase it out by Jan. 1, 2014, and help practices move to other options over the next several months. Availity representatives say the com- pany no longer can bear the administra- tive costs associated with maintaining the free transactions, particularly after HIPAA 5010 and ICD-10 requirements took effect and required additional sup- port. The company had offered the com- plimentary claims-exchange service to incentivize practices to use electronic claims filing for both private and public payers.


The change is expected to impact


roughly 15,000 individual physicians and groups in Texas that are currently submitting government claims through Availity. It does not affect physicians who use the Availity network to ex- change claims with other payers that cover the costs. Availity began notifying affected phy- sicians of the change by letter and is working with practice management ven- dors to offer other service options. The Texas Medical Association also will communicate with affected mem- bers about how to find an alternative. Because practices vary, however, TMA does not endorse a particular vendor. TMA Payment Advocacy staff rec- ommend that practices do not delay in searching for a replacement vendor to avoid disruptions in claims submission and payment.


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