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CMS Temporarily Delays Implementation of Ordering and Referring Denial Edits

Due to technical issues, the Centers for Medicare and Medicaid Services (CMS) has temporarily delayed implementation the ordering and referring denial edits originally planned for May 1, 2013. A new implementation date has not yet been announced. Despite the delay, we urge physicians who refer or order services for Medicare beneficiaries to enroll with Medicare Read more

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Palmetto GBA’s Appeal Denied Again, Noridian Will Be The New Contractor!

The U.S. Court of Federal Claims has denied two protests that were filed challenging a decision by the Centers for Medicare and Medicaid Services (CMS) to award the Medicare Administrative Contractor (MAC) contract for Medicare Parts A and B in Jurisdiction E to Noridian Administrative Services. CMS and Noridian will now move forward to implement Read more

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Anthem Blue Cross Agrees to Pay $3.2 Million Owed to Providers

Anthem Blue Cross will pay more than $3.2 million owed to physicians and other health care providers on improperly paid claims dating back to 2007. The agreement, announced this week by the California Department of Managed Health Care (DMHC), stems from claims audits launched by DMHC in 2008 of the 7 largest health plans in California Read more

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Medicare is Reorganizing, How Will This Affect You?

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) authorized the Centers for Medicare & Medicaid Services (CMS) to make significant changes to the Medicare fee-for-service program’s administrative structure that will make the Medicare program “dynamic, competitive and performance-based”.  Subsequently, CMS replaced the fiscal intermediary (FI) and carrier contracts and integrated the administration Read more

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Single Health Plan for 456,000 Californians Coming Soon

Beginning October 2013, Californians who are eligible for both Medicare and Medicaid (Medi-Medi) will have to sign up with one single health plan. This is as a result of a signed Duals Demonstration Memorandum of Understanding (MOU) on March 27, 2013 between California’s Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS). This Read more

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New DMV Requirements for Physicians Giving Medical Exams

Effective May 21, 2014, for the first time, require that all medical professionals who provide physical qualification examinations for truck and bus drivers to be certified and registered by the Federal Motor Carrier Safety Administration (FMCSA). The National Transportation Safety Board (NTSB) recommended creating a National Registry of Certified Medical Examiners to unify medical oversight Read more

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