Monday, March 18, 2019
Reimbursement Medicare / Medi-Cal

Medicare / Medi-Cal News

Don't forget to check Medicare patients' eligibility! Traditional Medicare doesn't require much pre-authorization, but Medicare HMO's often do. Medicare could deny your claim if your patient switches to an HMO, then the HMO could deny your claim because you didn't have prior authorization.

When documentation is required to process a Reopening, providers must submit the request as a Written Reopening with a completed "Reopening Form" or through Endeavor. If a request is more complex, beyond clerical errors or omissions, it is appropriate to submit a Redetermination via the "Redetermination Form."

For more Telephone Reopening information, go to https://med.noridianmedicare.com/web/jeb/topics/appeals/telephone-reopening.

 

 

 

 


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Begin Reporting PQRS Now To Avoid Penalties

The Medicare Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. PQRS is mandated by federal legislation.

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