Medicare Claim Hold The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release. The problem impacts claims received by the Medicare contractors (Palmetto GBA for California) on or after April 1, 2013. April 1, 2013 Medicare, Payment Medicare, Medicare claim hold 0 0 Comment Read More »
Medicare Ordering/Referring Claims Denials to Take Effect May 1 Medicare will begin denying claims on May 1, 2013, if the ordering/referring provider listed on the claim is not in the Provider Enrollment, Chain and Ownership System (PECOS), the database Medicare uses to track physicians and other providers. March 27, 2013 Medicare, Payment, Physician Resource Medicare, Medicare ordering/referring, CMS-855o, PECOS 0 0 Comment Read More »
Blue Shield Requires Physicians to Notify Patients Before Referring Out-of-Network On March 15, Blue Shield announced that it would soon begin requiring contracted physicians to notify patients in writing before making out-of-network referrals. Effective May 15, physicians will be required to notify patients in writing using a form provided by the payor when referring a patient to an out-of-network provider. March 27, 2013 Payment Blue Shield, managed care 0 0 Comment Read More »
Update on Medicare MAC Contract Protest Department of Justice to decide Medicare MAC contract protest after complaints filed in February 2013. March 15, 2013 Medicare, Payment Jurisdiction E, Medicare MAC, Palmetto GBA, Medicare, Nordian 0 0 Comment Read More »
Feds Allows States to Cut Medicaid Pay, Files Brief in CMA Court Battle The U.S. Department of Justice filed a brief last Friday before the Ninth Circuit Court of Appeals arguing states can cut Medicaid (Medi-Cal in California) providers’ reimbursement as long as it does not harm access to care. March 8, 2013 Advocacy, CMA, Medi Cal, Medicaid, News, Payment Medi-Cal cut, CMA et al. v. Douglas et al., Medicaid, Medi-Cal lawsuit 0 0 Comment Read More »
