September Updates from the ACR Insurance Subcommittee

• In the spring, Cigna announced that effective August 13, claims billed with modifier 25 would be immediately declined unless accompanied by a full set of office notes. In doing so, Cigna would exacerbate the existing administrative burden on rheumatology practices.
• The ACR sent a letter to Cigna expressing concerns that the policy would result in inappropriate denials and/or delayed payments for legitimate services.
• Cigna subsequently delayed the policy indefinitely and we are continuing to monitor for further developments.

Prior Authorization

• We have heard from numerous members about challenges with increasingly burdensome prior authorization processes.
• CVS and Express Scripts were specifically noted for both the overall length of their forms and the irrelevance or redundancy of many questions.
• The ACR has engaged both CVS and Express Scripts in an ongoing dialogue aimed at streamlining prior authorization forms to reduce administrative burden and avoid potential delays in patient care.

The ISC is here to assist practices as they navigate challenging insurance issues. If you have concerns about a payer policy or would like help with an issue impacting your practice, complete the Health Plan Complaint Form or email [email protected].

Thank you for your investment in the greater community of our shared specialty. Together, we remain committed to delivering exceptional patient care.

Rebecca Shepherd, MD, MBA, FACR, FACP, is the chair of the ACR Insurance Subcommittee of the Committee on Rheumatologic Care. She is chief of rheumatology and director of the osteoporosis service line at Lancaster General Health in Lancaster, Pa.