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Are your Medi-Cal payments being delayed due to patient eligibility?

Checking patient’s eligibility can make the difference in your reimbursement. Make sure your office staff is checking your patients Medi-Cal eligibility at each visit. Circumstances change all the time, your patient may be covered by Medi-Cal one month and the following month be covered by an HMO or Commercial Insurance, if eligibility is not verified you can risk your claim payment being delayed and/or reduced. To verify your patients eligibility simply log on to www.medi-cal.ca.gov or call the Automated Eligibility Verification System (AEVS) at 800-456-2387.

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Fiscal Year 2010-11 State Budget Reimbursement Contingency

Since the State of California did not enact the fiscal year 2010-11 budget by June 30, 2010, the Department of Health Care Services (DHCS) will direct the fiscal intermediary, HP Enterprise Services, to implement provisions pursuant to state law, to continue processing and adjudicating claims as outlined below.

HP Enterprise Services will process and adjudicate claims for the following programs, regardless of date of service:

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The Centers for Medicare and Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas. The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.

The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit. This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or "Welcome to Medicare Visit") with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient's individual risk factors.

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President Obama signed June 25 a bill that temporarily rescinds the 21.3 percent Medicare pay cut for physicians that went into effect June 1 and replaces it with a 2.2 percent update through Nov. 30. The best part for coders is that claims submitted during June before this bill was signed will automatically be reprocessed at the new rate.

According to the Centers for Medicare & Medicaid Services (CMS), the new law establishes 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates from June 1 through Nov. 30, 2010.  Medicare contractors have been instructed by CMS to discontinue processing claims at the negative update rates and to temporarily hold all claims after June 1 until the new rates are tested. CMS says it expects processing will resume by July 1.

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In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21.3% reduction in Medicare reimbursement to physicians and other health providers.

 A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.

 The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.

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