Meanwhile, Novitas underwent a technology transition of its own in Sep- tember that stymied its overall progress. Recent upgrades, however, will help ad- dress issues with Novitas’ website — an- other chief complaint among the prac- tices Texas Medicine interviewed. The carrier is fixing the online alert system and claims issues log so physicians can access them and find information more easily. Other planned enhancements, including a web-based provider portal, will allow physicians to submit claims and appeals online. “We have adjusted to the new nor- mal … and we believe we are poised to have markedly improved performance in 2014,” Mr. Vaughan said.
Enrollment issues top the list Before CMS approved the transition, Texas congressional leaders, TMA, and other state medical societies expressed serious concerns that Novitas lacked the capability to do the job, which meant taking on twice as many claims as it handled when it served only one region. Some physician practices say the
carrier’s performance so far has done little to alleviate those fears. “I think a year is a fair amount of time [to fix any problems] based on the fact that we as a state and TMA had grave concerns about Novitas taking over such a large state,” Ms. Searles said. “You know there are significant issues when I can tell [No- vitas representatives] more about what they are doing than they can tell me.” She says problems with the Medicare
enrollment process top the list. In her experience, the process through Medi- care’s electronic Provider Enrollment, Chain and Ownership System (PECOS) typically takes 60 days. Instead, physi- cian practices report that Novitas, which manages the electronic applications, is processing them in upwards of 90 to 120 days. In some cases, Ms. Searles says she had to do double duty when Novitas asked her to submit paper applications because representatives were unfamiliar with PECOS operations. Those hang-ups have significant rip-
ple effects, says Kim Stevens, a creden- tialing and insurance specialist for physi- cian groups across Texas and across the
country. She is a principal for Innovative Health Resources in Austin, a TMA-ap- proved practice management company. CMS acknowledges its own technical glitches getting PECOS to run smoothly. But now, PECOS is “foolproof” most of the time, she says, yet Novitas continues to lose applications or return them due to their own errors. “This impacts other areas of business for the providers.” Some physicians can’t bill for Medic- aid until they are enrolled as a Medicare provider, for example. And with com- mercial insurance carriers branching out into Medicare and Medicaid managed care, hang-ups in those programs can hold up physicians’ private contracts, too.
Enrollment issues also impact physi- cians’ ability to order and refer services to other doctors and for those refer-
ral physicians to get paid. As of Jan. 6, Medicare is denying claims for services ordered or referred by physicians not enrolled in the program. (See “Medi- care Will Deny Ordered/Referred Claims Without Enrollment,” page 30.) That means labs that fulfill orders for blood tests or specialists who perform imaging procedures, for example, will not receive Medicare payments if those services were ordered or referred by a doctor not enrolled in PECOS.
The consequences also could harm physicians’ referral relationships, Ms. Stevens adds. If physicians aren’t prop- erly enrolled, “it hurts referral patterns, and it impacts physicians financially be- cause they are losing business.” TMA’s Payment Advocacy staff are monitoring the enrollment issue, as well as its impact on physicians’ ability to or-
Five steps to smoother claims
Here are the top five things Novitas says physicians can do to help claims processing run more smoothly:
• Don’t send Medicare revalidation applications until request- ed. Sending them in advance can lead to processing delays.
• When enrolling, use the forms and reference materials pro- vided on Novitas’ website (
www.novitas-solutions.com) to aid in submitting accurate documents. Novitas says about half of initial applications require more information, which means delays in issuing a Medicare provider number.
• Consider using the electronic Provider Enrollment, Chain and Ownership System (PECOS) application rather than paper forms for enrollment.
• When applicable, use the forms Novitas provides on its web- site, particularly for appeals (redeterminations and reopen- ings), which facilitates accuracy.
• Check periodically for podcasts, events, and other educa- tional activity on Novitas’ website for the latest Medicare updates. For example, the transition to ICD-10 in 2014 will be a significant change for physicians.
March 2014 TEXAS MEDICINE 29
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