Five Answers You Won’t Get From Insurance Carriers

Have you ever called a carrier and asked why something was denied? If you work in a rheumatology practice, chances are you have, and you probably hung up feeling even more confused than before you made the call.

ACR Coding and Reimbursement Specialist Melesia Tillman, CPC, CCP, jokingly says, “This is the insurance company’s sneaky way to drive you all mad,” but she knows the joke often seems to be on the confused caller who is trying to provide quality care for a patient.

With nearly 20 years of previous experience working directly for insurance carriers, Tillman has come to the conclusion that, “to survive in today’s insurance game, your staff should be fully aware of what a carrier is actually requesting from you in order to get your claims processed correctly.” It is frustrating to discover that many of the quirks of the system cannot be worked around, but understanding why you are told certain things and noting what steps you can take to move things along will help you better run your practice and save you time, energy, and frustration.

Tillman gives you an insider’s perspective to five commonly asked questions about insurance carriers:

Moving to an EMR

From the new and innovative practice models to the consumerization of health care, the ACR practice advocacy department is committed to keeping abreast of threats, opportunities, and changes that will affect rheumatology practices today and in the future.

One recent change to the scope of practicing medicine is the growing demand for all medical practices, regardless of size, to go electronic.

The ACR understands that changing to an EMR system can be daunting, and new tools to help your practice cope with this movement are in the works. The ACR will soon launch its EMR User Review Web site, which will serve as a consumer review forum for ACR members who have an EMR in their practice to share their firsthand thoughts and experiences with other members who are looking to invest in a system for their practices.

In addition, the ACR is hosting an EMR vendor challenge at this year’s ACR/ARHP Annual Scientific Meeting. This challenge will feature four top EMR system demonstrations using a preset, rheumatology-specific mock patient–provider encounter. Not only will this event introduce attendees to the EMR systems, it will demonstrate a simple method to conduct in-office demonstrations that will cut through the vendor sales pitches and to the core functionality and usability of the EMR.

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