Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for… [Read More]
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Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,… [Read More]
Coding Corner Question: An Insurance Billing Quiz
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not… [Read More]
New Wins, Ongoing Challenges for ACR Insurance Subcommittee
Corrections to reimbursement system errors with Aetna and a Medicare contractor demonstrate the latest wins for all providers by the ACR’s Insurance Subcommittee. But the committee remains hard at work advocating for rheumatologists on several fronts. ... [Read More]
Bringing a Frontline Perspective to Insurance Advocacy
Early in his career as a resident at Washington University in St. Louis, Mo., Christopher Phillips, MD, felt a connection to his patients battling rheumatic diseases. Today, Dr. Phillips balances time with his solo private practice in Paducah, Ky., to help rheumatologists fight insurance battles for their patients in his role as chair of the… [Read More]
New York City Launches $100 Million Universal Health Insurance Program
NEW YORK (Reuters)—New York City has launched a $100 million health insurance program to cover 600,000 uninsured residents, including those unable to afford coverage and those living in the United States illegally, Mayor Bill de Blasio said on Tuesday. De Blasio, now in his second term as mayor of the country’s most populous city, has… [Read More]
Sign-ups for 2019 Obamacare Insurance Fall to 8.5 Million People
NEW YORK (Reuters)–The number of Americans who signed up for 2019 insurance plans created by the Affordable Care Act, often called Obamacare, fell by about 4 percent to 8.5 million people from 2018, the U.S. government said on Wednesday. Enrollment had been running about 10 percent lower but picked up during the past week, reflecting… [Read More]
Protect Your Practice: Action Update From the ACR’s Insurance Subcommittee
Both private and academic rheumatology practices face payer challenges that put the health of their patients and their practices at risk. To make sure the rheumatologist perspective is heard by payers, “the ACR’s Insurance Subcommittee (ISC) serves as the interface between payers and our members and ACR colleagues,” explains Sean Fahey, MD, a rheumatologist in… [Read More]
California Insurance Commissioner Sues AbbVie over Humira
(Reuters)—On Tuesday, Insurance Commissioner Dave Jones filed a complaint on behalf of the State of California against AbbVie Inc., alleging the drugmaker gave illegal kickbacks to healthcare providers to prescribe its blockbuster drug, Humira. The regulator alleged that AbbVie engaged in a far-reaching scheme including cash, meals, drinks, gifts, trips and patient referrals, as well… [Read More]
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,… [Read More]
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