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






Preventive Services Chart

Preventive Services Chart

RACs Are on Hold

CMS's agreements with recovery audit contractors (RACs) to administer the recovery program is winding down.

Incarcerated Medicare Beneficiaries

CMS is making changes to claims processing system...

First of the Increased Medi-Cal fee-for-service Primary Care Payments to go Out This Week

CMS recently approved California's proposed implementation plan for the primary care rate increases...

What you need to know about signatures and documentation

The discovery of CERT errors may lead to increased scrutiny of future services billed to Medicare. Your support and understanding of this important issue are essential to ensuring the accuracy of Medicare claims.

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.

Sequestration FAQ

On Friday, March 1, the automatic sequestration of federal spending is scheduled to take effect. The sequester was originally set to begin on January 1, 2013, under provisions of the Budget Control Act of 2011.