“Intentional or not, these delays are causing harm to a lot of people and will make the situation worse for patients in Texas if it’s not fixed.”
track with the complaints TMA has re- ceived and said they continue to monitor Novitas’ performance. 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. According to CMS, JH has more than 255,500 Part B providers — half (126,244) in the state of Texas — making this the largest Medicare admin- istrative contractor jurisdiction and the largest transition CMS has overseen. No- vitas, formerly Pennsylvania-based High- mark Medicare Services Inc., took over from TrailBlazer and two other contrac- tors in November 2012. Novitas already administered Part A and Part B claims for Jurisdiction 12, which includes Dela- ware, New Jersey, Pennsylvania, Mary- land, and the District of Columbia. At the start of the transition, Novitas
the most part, went as expected. “Our experience in many ways was not unlike what typically happens when workload is transferred to another contractor: It is a time of adjustment for the incoming contractor as well as stakeholders, in- cluding physicians. For Novitas Solutions, this involved establishing the infrastruc- ture and staffing needed to support a very large workload,” he said, adding that the transition was the largest of its kind in the country, representing ap- proximately 10 percent of the national Medicare fee-for-service claims. Although some unexpected issues did pose challenges — appeals and enroll- ment-related filings, for example, surged to unprecedented levels nationally — Mr. Vaughan reassures physicians that Novi- tas is poised to smooth the path for phy- sicians going forward. “We have responded aggressively from the beginning in a variety of ways to the changing conditions, which included additional hiring, modifications to our business model, and emphasis on im- proving the customer’s experience. We have made strides, but we are not done,” he said. “The gap between where we are and where we expect to be has closed considerably. We know where we need to go and have detailed plans to achieve our goals in 2014.”
28 TEXAS MEDICINE March 2014
TMA officials expected that a transi- tion of this scale would mean a period of adjustment. While payment problems with Novitas are not wholesale, TMA Payment Advocacy Director Genevieve Davis says the ongoing and often unnec- essary administrative hassles that trans- form into payment problems have gone on long enough. TMA also urges Novitas to remain transparent about issues that arise so physicians can plan and respond accordingly. Physicians are encouraged to log their complaints with the TMA Hassle Fac- tor Log so TMA can continue to closely monitor Novitas’ operations, step in to investigate problems, and work with Novitas to resolve them. Download the Hassle Factor Log online at www.texmed .org/hassle, or contact the TMA Knowl- edge Center at (800) 880-7955. TMA also remains in regular conver- sations with the Centers for Medicare & Medicaid Services (CMS), which ap- proved Novitas as the regional Medicare contractor in 2011. Ms. Davis says CMS must do its part, too, to oversee the car- rier it chose to handle Medicare claims in Texas and six other states.
Overall, CMS officials said the tran- sition “has gone relatively well,” consis- tent with past transitions. But they, too, pointed out some shortcomings that
representatives told Texas Medicine that the company’s No. 1 goal was to not in- terrupt cash flow. Mr. Vaughan says that overall that stated priority was achieved.
“At a high-level look, total payout was consistent with the outgoing contractors. Our claims-processing timeliness was ex- ceptional, hovering around 99 percent of all ‘clean’ claims paid within 30 days.” He acknowledges that during the transition, Novitas experienced a flurry of fiascos, for example, when some re- coupments of overpayments went on longer than expected. The company has since resolved those issues. And as of Sept. 1, 2013, Novitas eliminated back- logs in physician appeals and was in line with the CMS requirements to process those claims within 60 days. Except for a few appeals left by TrailBlazer, Novitas is no longer processing claims and appeals using old TrailBlazer policies, which also streamlines those processes. Doctors do not have to refile old TrailBlazer claims, and that part of the transition is consid- ered to be over, CMS said.
Novitas also continues to improve customer service through its Provider Contact Center, “and we expect the out- come of these improvements will be bet- ter, more accurate, and helpful responses for providers, along with response times showing better than industry average,” Mr. Vaughan said.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68