MEDICAL ECONOMICS
Problem pile-up Novitas issues persist one year on
BY AMY LYNN SORREL Novitas Solutions Inc. took over from TrailBlazer Enterprises as Texas’ Medicare carrier more than a year ago. But ongoing frustrations with customer service short- falls, enrollment delays, and heavy auditing practices, among other complaints, have Texas physicians giving the contractor a shabby report card. They say the bad grades still add up to too many hassles and payment problems and not enough answers.
Unbeknownst to one doctor Texas Medicine spoke to (who wished to remain anonymous), Novitas misinterpreted his business and tax status when he renewed his Medicare par- ticipation last May. He didn’t find out until his office manager was greeted by a letter and a series of rejected claims — $15,000 to $30,000 worth — that piled up after Novitas deactivated his Medi- care billing privileges. That’s a lot of revenue at stake for a solo practitioner with nearly half of his patients on Medicare, says the physician, who also no- ticed an uptick in document re- quests and recoupments, even for patients the doctor treated and re- ceived payment for years ago under TrailBlazer’s watch. Even the practice’s credential- ing specialist couldn’t get to the bottom of the issue after spending hours on the phone with Novitas representatives. But once the phy- sician enlisted help from the Texas Medical Association’s Pay- ment Advocacy Department, his case was resolved in a matter of days.
“If Novitas’ job is to make payments for medical care more difficult to obtain, then it is doing its job, but not in a way that is fair to the physicians providing care,” the physician said. TrailBlazer was by no means perfect, but Novitas “is not any more accessible, and they’ve created more headaches and take-backs [recoupments] than I’ve seen in the eight years I’ve been in private practice. So, I hope it gets better. This is
“Fortunately, I am lucky
enough to have TMA as an
advocate for our physicians.”
not just my career, but the livelihood [of my employees and practice]. I understand and fully agree that we must act with caution when billing anyone, government or not, for health care services. But it’s always been true that if it’s not good for physicians, eventually it’s not good for patients either.” Similarly, a six-month delay with renewal cost one rural family physician with Texoma Independent Physicians $6,000 in denied claims. It then took another two months to get paid, says Patti Searles, executive director of the independent prac- tice association. Delays in the initial Medicare enrollment pro- cess also cost a new dermatologist to the practice more than $250,000 in delayed claims. Ms. Searles spent three months going back and forth with Novitas to get to the bottom of the issue, to no avail. Until TMA stepped in. “If you’re not enrolled, you don’t get paid. And new physicians com- ing in to practice on their own, with no cash flow and no salary, can’t go four to six months with- out getting paid,” she said. “I agree, some providers don’t know the proper way to enroll. But we have 189 physicians, and we’ve been do- ing this for them for a long time now. We know the proper way to enroll, and that’s what gave us an understanding that this is a system- ic problem [on Novitas’ part]. It is not just the providers.” Thanks to TMA’s help, Ms. Sear-
les says the enrollment issues have improved. “But not because there are fewer issues. Fortunately, I am lucky enough to have TMA as an advocate for our physicians. I now have a contact at Novitas who works directly with me to resolve issues. This should be the rule, though, not the exception.”
A rocky start David Vaughan, Novitas vice president and project manager for the region that includes Texas, acknowledges that the car- rier still has room for improvement, but says the first year, for
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