Coding compliance: The ACR employs two certified professional coders, Melesia Collins and Resaee Freeman, who are available to answer coding questions and address insurance problems. If you have a problem receiving reimbursement for imaging studies or medications, contact our coders. Sometimes the problem can be handled by adjusting your coding; other times, a letter may need to be sent from the ACR requesting that the insurance company change their policy. The coders have assisted hundreds of members with proper coding and have saved members thousands of dollars.
The ACR coders also attend state and local rheumatology society meetings and provide CME coding presentations. In 2006, the ACR coders gave 17 coding presentations throughout the country; they hope to attend even more of these meetings in 2007.
One-on-one assistance: If you have a question related to your practice and want to talk directly with another physician, start with your regional advisor. The ACR Regional Advisory Committee is made up of regional advisors who are available to discuss insurance and practice management issues related to a specific region or state. If you feel your issue is broader in scope, feel free to contact any member of the ACR Committee on Rheumatologic Care (CORC). During the past year, the ACR CORC and regional advisors have successfully changed some insurance company policies to assist practicing physicians. Selected achievements include:
- Convincing an insurance company to change its policy that patients on anti-TNF medications must also be on methotrexate;
- Changing a non-coverage decision by an insurance committee that would not allow patients to receive IV ibandronate sodium if they were unable to take the oral version;
- Reopening a comment period for an insurance company trying to restrict the number of c-reactive proteins that can be reimbursed during a year; and
- Convincing an insurance company to change its policy requesting additional documentation when reporting modifier -25.
The regional advisors also attend state and local rheumatology meetings to review relevant ACR activities, discuss the issues faced by members in your area, and gather feedback on what services and resources the ACR can offer to better assist you in your practice.
Practice tools: At Rheumatology.org, we offer nearly two dozen practice management tools for use with documentation (including academic tools for teaching physicians and pediatric-specific tools), HIPAA compliance, and fee schedule and coding assistance. In our “Patients & Public” section we offer more than 50 complimentary patient education pieces on diseases and related issues, medications, and the role of caregivers. I encourage you to refer patients to these resources or—better yet—print them and make them available in your office or clinic. Also available online is the 2006 ACR Coding in Rheumatology manual, the rheumatology-specific adjunct to the AMA’s CPT manual.
