The ACR Regional Advisory Council (RAC) met in March to discuss reimbursement issues affecting rheumatologists in various regions. The RAC was established to assist physicians with reimbursement concerns. Here are some of the RAC’s current initiatives:
- IV ibandronate sodium denials: Trailblazer Health, a Medicare Part B carrier, has been denying physicians reimbursement for IV ibandronate. The ACR has been working on this issue for several months, and recently sent a letter to Trailblazer regarding these denials, explaining that some patients are unable to take the oral version of ibandronate. The RAC continues to educate carriers about this issue, but physicians should document the reason a patient was not prescribed the oral version in their medical records.
- C-reactive protein test limits: Trailblazer also released a draft policy limiting the number of C-reactive protein tests that may be ordered in a year. The ACR sent a response letter, and the limit was removed from the final policy.
- Concurrent methotrexate and infliximab treatment: ACR list serves have had extensive discussion regarding concurrent methotrexate and infliximab treatment. The council is working on this issue. The RAC would also like to thank list serve members that report reimbursement issues.
The RAC is made up of ten advisors and a chair, supported by certified professional coders on the ACR staff. The group meets in person twice a year and via conference call bimonthly, and monitors the list serves for potential concerns.
If you have reimbursement concerns, please contact your regional advisor or e-mail one of the ACR coding specialists, Melesia Tillman, CPC, mtillman@rheumatology.org or Resaee Freeman, CPC, rfreeman@rheumatology.org.
Both the advisors and coders can speak to your state or local society meeting. Advisors present on current ACR issues; professional coders on evaluation and management codes. To schedule a presentation, contact the practice advocacy department at (404) 633-3777.