Questions What type of drug is interchangeable with an FDA-approved biologic? What drug is used in conjunction with infliximab, unless the patient cannot tolerate it? What can be used as a key element in an evaluation and management (E/M) service, along with the history, exam and medical decision making? What drives the level of an…
Although the Centers for Medicare & Medicaid Services (CMS) is simplifying documentation through its Patients over Paperwork initiative, clinical documentation improvement (CDI) did not go away. CDI is not about how to code in ICD-10-CM or the Current Procedural Terminology (CPT); instead, it is a huge part of the solution in maximizing the integrity of…
The Rheumatology Research Foundation is the charitable arm of the ACR, advancing research and training to improve the health of people living with rheumatic disease. Thanks to the continued support of ACR and ARP members, the Foundation is the largest private funding source for rheumatology research and training programs in the U.S. In all, the…
The ACR thanks all members who donated to RheumPAC this year. These contributions enable the ACR to educate key legislators and their staffs about the important issues rheumatologists and rheumatology professionals face. Every dollar raised goes directly to the re-election campaigns of legislative leaders in our field to help those who best understand our issues…
Contributions from ACR/ARP members and volunteer leaders raised more than $36,000 in November to support rheumatology advocacy efforts.
It’s time to prepare for 2019 MIPS reporting via the Rheumatology Informatics System for Effectiveness (RISE) registry, and the ACR is here to help. To ensure you’re ready to submit your data to the Centers for Medicare & Medicaid Services (CMS), RISE users should take the following steps: Review your data in the dashboard; Make…
Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…
Legislation introduced in both houses of Congress would set a minimum Medicare reimbursement of $98 for DXA bone density scans.
Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…
A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…