How Do I Know If A Provider Has A PECOS Record?
Medicare Ordering/Referring Physician Files (PECOS) Medicare has not yet implemented the automatic denial for claims submitted with an ordering or referring physician who does not have a current PECOS record. CMS is working to clean up system problems and backlogs...
How to Get a Medicare Provider Number
Poor advice on the internet can lead to making the enrollment process even more confusing than it already is. eHow.com is a large reference site and I came across their article recently that describes "How to Get a Medicare Provider Number". See their site article...
Medicare physician payments 2013
At the last moment, Congress passed legislation to avert the drastic Medicare physician fee schedule reduction that physicians were facing for 2013. The American Taxpayer Relief Act of 2012 includes the following provisions impacting physician reimbursement: Prevents...
Medicare Enrollment Guidelines for Order/Referring Providers
Medicare Ordering/Referring Requirement The Affordable Care Act requires that all eligible providers be enrolled with Medicare to order/refer items to Medicare beneficiaries. Providers who do not submit claims to Medicare must still be enrolled with the program to...
CMS PQRS for 2013
Medicare PQRS Guide The 2013 PQRS Measures and Implementation Guide are now available on the CMS website. The PQRS measures guide contains information on reporting PQRS measures for 2013. Providers who don't meet the 2013 reporting requirements will realize a -1.5%...
Medicare Provider Participation Agreement (CMS460)
Medicare Provider Participation Decisions Due By December 31st Medicare providers have until December 31st of each year to make changes to their participation decisions. The Participation Agreement (CMS460) is originally filed with Medicare provider enrollment...
States Lean on Feds for Health Insurance Exchanges
With little direction from the federal government, more states are leaning towards the federal insurance exchange to meet coverage requirements of the Affordable Care Act. Open enrollment for insurance exchanges for 2014 begins in October 2013, so a lot needs to...
Aetna to join 15 insurance exchanges
Aetna announced that by 2014 it expects to be part of 15 or more insurance exchanges being established under healthcare reforms. The Affordable Care Act is expected to bring 30 million new insured lives over the next decade and millions of those will be...
PPO USA network to close
The Affordable Care Act continues to have dramatic impact on our industry. Smaller insurance networks are struggling to cope with the mandates in ACA. GEHA announced several months ago that PPO USA will cease operations effective 12/31/12. GEHA will work with...
Medicare Re-Validation Update
Medicare Revalidation CMS has extended the period for provider revalidation to March 2015. This update doesn't affect any providers who have already received a revalidation notice. If you have already received a revalidation notice, you have 60 days to complete a...
Medicare Provider Payments (EFT)
Medicare Provider Payment Method Requires Use Of EFT Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment with the Medicare program (initial enrollment, enrollment record change, or re-validation), providers and suppliers must agree...
Medicare Provider Enrollment – Site Verification
Medicare Provider Enrollment News CMS contracts with a third party to provide site visit services as an integral part of the Medicare Provider Enrollment process. The National Sive Visit Contractor (NSVC) will conduct site visits for all providers and suppliers...
