went their paychecks. Prepay audits are nothing new, but Dr. Mattar’s staff say the clinic never experienced this level of auditing with TrailBlazer. And despite regular phone calls to Novitas, the clinic receives little explanation for the ongo- ing scrutiny. “We are practicing the same way we
did under TrailBlazer. We provide good quality care. Yet we are receiving our pay very late, and we are under more reviews and what seems to me like de- lay tactics,” Dr. Mattar said. As a resident training program, “we produce doctors for the state. And they [Novitas] have to know that we [physicians] count on those payments and the timeliness of payments. Intentional or not, these de- lays are causing harm to a lot of people and will make the situation worse for patients in Texas if it’s not fixed.” Mr. Vaughan said Novitas “currently
reviews a small percent of randomly chosen claims for certain E&M services as part of its prepayment edit process.” Reviews are based on error trends, and approximately two-thirds of all payment errors are associated with E&M services, he says. Some reviews may be specific to a provider, others to a service, so “pro- viders who bill large numbers of the par- ticular service will naturally have more claims selected as part of a service-wide review.”
He pointed physicians to a list of ser-
vices that Novitas reviews on the Medi- cal Review page of its website (www
.novitas-solutions.com), along with edu- cational resources for E&M services. He said the resources also address physi- cians’ responsibility to submit accurate and complete Medicare revalidation ap- plications and provide address updates to avoid payment suspension.
Glimmers of hope Amid physicians’ troubles are some glim- mers of hope for improvement. When claims processing is smooth, Ms. Searles says Novitas generally pays them within 15 days.
Customer service is better, too, Ms. Stevens noted. And when it works, an enrollment status tracking tool on No- vitas’ website helps her stay on top of physicians’ PECOS applications. In the
past two months, she noticed that ap- plications were processed more quickly. TMA’s Ms. Davis added that Novitas helped TMA identify physicians who had not completed their electronic funds transfer forms on time so their payments could be directly deposited without cash flow interruptions.
Novitas also continues to partner with TMA on its annual Medicare edu- cational seminars in various locations throughout Texas. CMS says claims processing and pay- ments were “unencumbered, on the whole,” with Novitas processing 99.4 percent of Part B clean claims within 30 days. They confirmed that appeals processing is back on track, and Novitas is handling written inquiries to the Pro- vider Contact Center in a timely manner. But the carrier continues to struggle when it comes to the phones, with aver-
age call wait times and completion rates
“well below” CMS standards. Meanwhile, backlogs in enrollments are “growing,” CMS said. Novitas received more appli- cations than what it had projected and was staffed to handle, although CMS confirmed that enrollment increases are affecting several Medicare carriers throughout the country. Still, these two areas — the Provider Contact Center and enrollment — rep- resented the “most persistent, recur- ring complaints we have heard directly regarding Novitas’ operations in Texas,” CMS said.
The agency has not issued any correc- tive actions, but says Novitas proactively submitted its self-improvement plans. The technology transition in September caused some setbacks, but Novitas has since hired outside consultants and tem- porary staff help to move forward.
TMA Hassle Factor Log to the rescue
Physician members can get 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 may contact the TMA Knowledge Center at (800) 880-7955 or at
knowledge@texmed.org
March 2014 TEXAS MEDICINE 31
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