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






Sequestration FAQ

How will the cuts affect Physicians?

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. Under the act, a Joint Select Committee on Deficit Reduction (the so-called "super committee") was charged with developing a plan to achieve $1.2 trillion in federal spending cuts over 10 years to avert automatic, across-the-board cuts. That process failed.

Legislation signed into law on January 2, 2013, delayed the cuts for two months to provide time to develop an alternative savings plan, but at this point it does not appear that Congress and the White House will reach an agreement in time to stop the sequestration cuts.

The $85.4 billion 2013 sequester included: (1) a 7.9 percent cut in defense spending, for savings of $43 billion; (2) a 5.3 percent cut in domestic discretionary cuts, for savings of $29 billion; (3) a 2 percent cut in Medicare provider payments, for savings of $10 billion; and (4) 5.8 percent cuts to defense and non-defense mandatory programs to achieve $4 billion in savings. Certain safety net programs, including Medicaid are exempt from the cuts.

Download CMA's FAQ sheet to learn more.