Effective Sept. 1, 2018, United Healthcare’s (UHC) new policy for National Drug Code (NDC) reimbursement will require providers to include additional drug-related codes submitted on the CMS-UB04 and the Electronic Data Interface (EDI) transaction 837i. All outpatient claims submitted to UHC commercial and UHC Medicare Advantage plans with a date of service on or after…

How to Document the Physical Exam
The adage frequently cited in healthcare settings, “If it isn’t documented, it wasn’t done,” still rings true for the key components required in a patient’s medical record. The note in the medical record must sufficiently describe all of the services furnished to patients on a specific date. The essential requirements to appropriately bill a claim…
Coding Corner Answer: Evaluation & Management Documentation Quiz
Take the challenge. B—The presenting problem(s) is what is evaluated during the history and examination by the provider. The chief complaint is in the patient’s own words or is a follow-up for his or her current condition. The history of present illness, along with the review of systems, usually guides the provider through the examination….
Coding Corner Question: Evaluation & Management Documentation Quiz
Evaluation & Management Documentation Quiz What element drives an evaluation and management (E/M) visit? The chief complaint in the patient’s own words of why he or she is in the practice for that date of service. The presenting problem(s) being discussed with the physician for that patient during the visit. The examination performed on the…

COIN Launches Playbook to Reach Young Adult Audiences
The ACR’s Collaborative Initiatives (COIN) department develops and tests innovative solutions for complex rheumatology care problems. “All of the work COIN does—programs toward health equity, creating models to increase rheumatology-related capacity in places of need, building bridges with local and national patient organizations—is done on [behalf of its members],” says Dr. David Daikh. Each month…

CMS Releases 2018 MIPS Eligibility Tool
You can now use the updated Centers for Medicare & Medicaid Services (CMS) MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-Based Incentive Payment System (MIPS). Enter your National Provider Identifier (NPI) in the tool to find out whether you need to participate during the 2018 performance year. Changes to…

2018 ACR/ARHP Annual Meeting Courses, Opening Lecture & Keynote
Join us in Chicago for the 2018 ACR/ARHP Annual Meeting on Oct. 19–24. Register now to save; advance registration rates end Oct. 3. High-Impact Learning Starts with Pre-Meeting Courses Pre-meeting courses offer attendees unique learning opportunities in specific topic areas. The pre-meeting courses will be held at McCormick Place Oct. 19–20. No matter your area…

Rheumatology Research Foundation Announces Grant Recipients
On July 1, the Rheumatology Research Foundation awarded grants to a wide range of rheumatology trainees and professionals. The recipients will receive funding for essential education and training, as well as innovative research projects. Their applications were closely examined by experts in different areas of the field to ensure awards went to the most promising…

Ethics Forum: What to Do with the Inherited Opioid Patient?
A 67-year-old man with a recent onset of diffuse muscular pain and stiffness and an erythrocyte sedimentation rate of 55 is referred to you by his family practitioner. He has a history of non-insulin-dependent diabetes mellitus, but no history of headaches or swollen joints. He has chronic back pain, has had two surgeries and was…

Rheumatologist Spotlight: Robert Simms, MD, Triathlete
Every single morning—even on weekends—Robert W. Simms, MD, wakes up at 3:45 and is out the door by 4:30 to swim, run or cycle for at least one hour. After weekday workouts, he then heads to his job at Boston University (BU) School of Medicine, where he serves as professor of medicine and rheumatology section…
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