DENIAL OF PAYMENT BY NOVITAS, THE ADMINISTRATOR FOR MEDICARE

I have not written for a while because so much of my time out of work is spent on appealing denial of payments by Novitas, the Medicare administrator for Texas.  They have denied care for patients who have had treatments that are considered as class 1 evidence for management by all the major vascular societies, including the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation, and Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).  In 25 years of doing this work, I have never encountered such nonsense.  I thought I was the only one going through this trouble.  Then I find out that a cardiology colleague of mine in South Dallas has the same issue.  By word of mouth, I talked to a cardiologist in Illinois who just went through the same  problem.  I bet there are more physicians that are being inappropriately denied payment for standard of care by Novitas.  Nothing against the profession, but I found out my cases were reviewed initially by a licensed vocational nurse (LVN).  Hell, even many physicians don’t fully understand what we do and why.  To add fuel to the fire, apparently Novitas keeps 12% of the amount of money that they recoup from physicians such as myself as a bounty.  When I reviewed a case with one of the Novitas nurses early in the course of this appeal, she told me “Well you know sometimes people need to have an amputation of their leg rather than an attempt at limb salvage.”  THERE IS SOMETHING GOING ON HERE, AND I WOULD LOVE TO HEAR FROM OTHER PHYSICIANS, BILLING PEOPLE, AND HEALTHCARE PROVIDERS ABOUT THEIR PROBLEMS WITH NOVITAS OR ANOTHER MEDICARE ADMINISTRATOR.

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