Provider Cites Payment Problems with Noridian

ATLANTA–A major HME provider in the Pacific Northwest says it
is shy millions of dollars because its Medicare Administrative
Contractor, Noridian Administrative Services, has not processed
those claims in two months.

“We have just over $3 million in claims sitting with them,” said
Angelene Adler, vice president of operations for Care Medical
Equipment. Based in Portland, Ore., the provider has 11 branches in
Oregon and Washington.

Sarah Hanna, vice president of ECS Billing & Consulting in
Tiffin, Ohio, also reported difficulties in getting claims paid in
the 17-state Region D. “There’s a higher denial rate in Region D
related to the 176 code–basically an issue regarding [certificates
of medical necessity],” she said.

Noridian officials have told ECS that the denials are occurring
because its server was moved to a different location, causing a
breakdown in communication between the server and its common
working files. That has resulted in the CMNs not being attached to
the claims, so the claims are being denied.

Noridian also told ECS that it is three to four weeks behind in
processing claims but that it will pay providers interest, said
Elizabeth Longbrake, accounts receivable supervisor for ECS.

“They are not making the 14-day turnaround,” Hanna said.

Adler said her company, which generates revenues of about $35
million a year, first noticed a problem in November. Since then,
the payments have been dribbling in. So far this month, Care
Medical branches have received checks ranging from 14 cents to
$34,000.

Adler said the company’s payments for claims have dropped 67
percent, and it is unable to process third-party payer claims. “We
can’t even bill these as denials because there’s no movement at
all,” she said. “It’s going beyond Medicare. It’s affecting our
Medicaid and HMO [claims].”

Care Medical’s attempts to talk to Noridian officials regarding
the claims have been fruitless, Adler said. Company staff members
have been told Noridian will only accept written complaints, but
their e-mails have either not been satisfactorily answered or not
responded to at all, Adler said. “They tell us to wait 30 days, but
we can’t afford 30 days.”

In last year’s switch from Durable Medical Equipment Regional
Carriers to DME MACs, CMS awarded Noridian the bid for Region D
over Cigna, which had been the area’s DMERC.

Adler said she is concerned that Noridian cannot handle the
work. She said staff members have received calls from Noridian
employees asking what a capped rental is and what a K0011 is.

“What we would like to see is Cigna reclaiming the contract,”
she said.

When HomeCare Monday contacted Noridian’s corporate
office in Fargo, N.D., about the payment issues, a representative
who answered the phone said she did not have time to comment.

According to Ann Howard, director of federal policy for the
American Association for Homecare, the association had previously
been talking with CMS about a different problem with Noridian
experienced by a California provider. Related to that issue, she
said AAHomecare wants to determine whether Noridian’s participation
in a three-state test as a Recovery Audit Contractor–rewarded for
rooting out erroneous claims on review–conflicts with its job as a
claims processor.

AAHomecare will follow up with CMS on Care Medical’s situation,
said Howard, noting that the association has heard from other
sources that additional providers are having problems. Meanwhile,
Howard says AAHomecare is trying to learn through state
associations and individual companies how far-reaching the payment
problems may be and if any have been resolved.

“This is serious stuff,” she said. “We need to hear from other
providers if they are having this same problem. If it is a systemic
problem, then we will have to get a fix on the program rather than
just trying to work on each case as it comes along, and, if need
be, get Congress involved … We’re totally prepared to do that if
we have to.”