Why Choose NHA?

NHA created, disseminated and tracked questionnaire/surveys for internal contractors. NHA provided detailed reports on questionnaire/surveys progress and results. NHA Created training policy and procedure modules for the Medicare community; in addition to creating static and playable 508 Accessible training. NHA prepared 150+ video and 150+ PDF modules for transfer to CMS’s Content Management System. NHA maintained Benefits Coordination & Recovery Contractor part of CMS’s Content Management System.

NHA created and maintained the LMS for CMS resulting in the training of 9,000+ users from 300+ companies. NHA created training policy and procedure modules for Medicare community as well as static and playable 508 Accessible training. NHA created, disseminated and tracked assessments for internal contractors as well as questionnaire/surveys for internal contractors. NHA provided detailed reports on assessment and questionnaire/surveys progress and results. NHA organized and facilitated both in person and online seminars for audiences of over 1,000 participants for CMS. In addition, NHA organized 1 on 1 training sessions with various insurers, attorneys and beneficiaries. NHA maintained LMS Help Desk.

NHA has developed and maintained a large Learning Management System (LMS). The LMS contains over 300 CBTs and has handled as many as over 9,200 registered users from all over the country.  NHA’s LMS has integrated teleconferences, online tutorials and webcasts at one location, our LMS, and can be accessed from any internet connection. NHA has demonstrated and continues to demonstrate exemplary customer service response time to LMS users technical issues that may be encountered with our CBT courses.

NHA assisted the prime contractor in developing evaluation protocols used during QIC evaluations; performing annual on-site evaluations for the Part A, Part B, Part C, Part D, and Administrative Qualified Independent Contractors and captured findings; assisting the prime contractor in developing evaluation report; responding to QIC rebuttal statements; as well as, evaluating the QIC’s adherence to CMS procedural requirements in accordance with the Statement of Work and task orders, including reviewing QIC’s reconsideration decision to determine quality, accuracy, consistency and timeliness.

NHA developed a database with the following functionality:  on-site data entry with built-in, real-time data validation; integrated Medicare Appeals System data repository with built-in analytics; automated report generation; automated scoring, longitudinal and cross-QIC analytics; and real-time tracking during audits.

NHA performed physician review of reconsideration decisions when the nurse reviewer disagreed with the QIC’s medical necessity decision.

NHA provided recommendations for revision to the CMS QIC Manual, Protocols, and Umbrella Statement of Work (USOW).

NHA reviewed sample reconsideration decision letters on a monthly basis to determine quality and accuracy.

Neil Hoosier, owner and founder of NHA, was instrumental in the creation of the Medicare Accounting Recovery and Tracking Initiative (MARTI) system.  His vision was the key factor for the success of its implementation.  This case control system tracks liability and WC, Medical Malpractice, and No-Fault cases.

Current members of the NHA team were responsible for developing, deploying and improving this system.  Once used only by Empire Medicare Services, this MSP debt collection case control system has become a National Liability Tracking and Reporting system because of the sole marketing efforts of Neil Hoosier.  This case control system allows users to generate demand letters and respond to incoming inquiries, track liability cases, track actions taken, and document all follow-up pertaining to the liability case.  Once the case is finalized because payment is received or a decision made (e.g., waivers/appeals), the case is closed and the data is archived for future reference. It is important to note that several financial reports are available in this system particularly a receivables report which details all collections, adjustments and write-offs.  

Recovery of mistaken primary payments on Medicare secondary payment (MSP) cases was historically done by a variety of claims processing contractors using a wide variety of processes and methodologies.  Eventually CMS determined that consolidation of this activity would be more efficient and less costly.  The immediate impediment to this consolidation was that no single system was available to perform the complex array of necessary activities.  A system was needed that would store the MSP period, retrieve and store the paid claims history, store the selection of claims to be recovered on, and establish and track the MSP debt. 

In 2005, NHA was awarded and successfully performed on a contract to develop the business and functional requirements for a single system that could interface with other CMS systems to gather and disseminate all the necessary data and perform all the activities necessary to implement a national MSP debt collection effort.  That system, called REMAS, was built using the requirements developed by NHA and is still being utilized by the national contractor that was selected to recover all MSP debts.

In its fifteen plus year history, NHA has undertaken and successfully accomplished a number of tasks critical to the overall success of the Medicare program.  Most recent of these tasks and one that is ongoing is the implementation of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, commonly referred to as Mandatory Insurer Reporting (MIR). 

 NHA, under the guidance of CMS, developed User Guides that provide information and instruction to Group Health Plans and Non Group Health Plans, including WC insurers.  The User Guides provide detailed information regarding reporting requirements, reporting processes as well as file specifications for the data that must be reported to CMS. 

NHA developed and produced a series of CBTs for the MIR project.  The CBTs were developed to inform, educate and assist insurers, including WC carriers that have reporting responsibilities.  CMS has sought and continues to seek assistance from NHA as it develops policy for MIR. 

NHA led the transition and consolidation of 50 Medicare contractors into a single national MSPRC, many of the tasks performed were similar in nature to the tasks performed by the WCMSA e.g., developing and implementing procedures to review incoming recovery cases, correspondence, waivers of overpayments and appeals.  Cases were checked to ensure relevant documents were submitted and procedures included development activities to obtain missing documents.

NHA developed joint operating agreements between the MSPRC and other entities, developed spreadsheets to delineate responsibilities for handling telephone calls between the MSPRC and other entities, participated in MSPRC risk assessment, developed training materials, developed standard operating procedures for all aspects of the recovery process and provided extensive training of personnel at all MSPRC sites.  NHA also developed on-line courses for the various systems used by the MSPRC and converted the standard operating procedures into on-line courses.  This contract has resulted in a recovery of over $550 million dollars for Medicare from October 1, 2006 through September 30, 2007.

CMS claims processing contractors for many years entered into agreements (generally referred to as trading partner agreements) with other insurers to forward Medicare claims payment data on Medicare beneficiaries for whom the other insurer had supplemental claims payment liability.  This was performed at the local level with each individual insurer entering into a separate agreement with each Medicare claims payment contractor which might process a claim for their insureds and required the insurer to provide eligibility files to each Medicare contractor.  There was no required standard format for either eligibility or claims files, no standard agreement between the trading partners and little if any controls on the collection of millions of dollars in crossover fees. CMS included conversion of this claims crossover process from the local contractors to a national program in the Coordination of Benefits Contract awarded to Group Health Inc. (GHI) in 2001. 

NHA, as a subcontractor to GHI, was assigned to design the national program.  This complex process required the establishment of a standard crossover agreement, negotiation of the signing of the agreement with over 1500 insurers, implementation of standard HIPAA compliant eligibility and paid claims formats, establishment of beneficiary crossover eligibility and claims selection criteria on CMS’s Common Working File (CWF), assisting insurers and CMS claims payment contractors with HIPAA transaction set compliance.  With NHA at the helm and utilizing the processes implemented by NHA, this huge and complex conversion was successfully completed.