The ISC has been busy this year dealing with issues such as denials for musculoskeletal ultrasound, unnecessary prior authorizations for generic medications and methotrexate, inappropriate step treatment programs, policy and formulary reviews, infusion questions, evaluation and management coding queries, and much more. “These are collective issues affecting rheumatology practices nationwide, and the subcommittee is dedicated to tackling these undue burdens aggressively,” says Dr. Perkins.
Payer Relationships
Since 2010, the ISC has worked diligently on building relationships with health insurance plans to improve the quality and cost effectiveness of healthcare for our patients. The ISC would like to continue having progressive and frank conversations with payers in all matters. The healthcare system is complex, and ensuring that the care provided is both high quality and cost effective is never straightforward. The ISC remains committed to providing input, advice, and expertise on medical policies affecting our membership.
The ISC has been instrumental in contributing to and providing feedback on medical policies on a monthly and quarterly basis with health plans such as WellPoint Health Network Inc., Regence BlueCross BlueShield, and United Healthcare.
In an effort to assist our members with insurance problems and inquiries, insurance resources have been created for members and their staff on the ACR website:
- Health Plan Complaint Form—The ACR developed this standardized complaint form to assist members in addressing both individual and system-wide insurance issues.
- Letter templates—Hot topics for members to communicate to insurance carriers.
- Medicare—Information such as Medicare fee schedules, information about Medicare Part D, and letter templates relating to Medicare issues are available to guide you and your staff.
- Model Biologics Policies—The ACR’s Model Biologics Access and Treatment Policies can be used nationwide to reduce administrative burden among rheumatologists, patients, and insurers, and allow you to properly treat patients without administrative delays. In an effort to make sure that the best care is provided to patients, the ACR also developed a standardized prior authorization form.
If you have an insurance issue, do not hesitate to ask the ISC for help! Keep in mind, the ISC cannot negotiate contracts for physicians, but is willing and able to investigate unfair practices from insurance companies that would put a patient or physician at risk. Join the ACR’s designated list serve to participate in insurance, coding, and payment discussions.
We look forward to serving you! If you have any insurance questions or issues, contact the ACR’s insurance and coding specialist Melesia Tillman, CPC, CPC-I, CRHC, CHA, at [email protected] or (404) 633-3777, ext. 820.
