Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity….
Articles by From the College
Rheumatology Board Certification: Exploring Change
The ACR has been engaged in a measured, inclusive process with rheumatologists to determine if rheumatology board certification should move from the American Board of Internal Medicine (ABIM) to the American Board of Allergy and Immunology (ABAI), which would become a new, combined board of Allergy, Immunology and Rheumatology. “As ACR leaders have traveled around…
Coding Corner Answers: Billing for Joint Injection within a Series
Take the challenge. CPT: 20611-LT, J7325-EJ ICD-10: M17.12, E66.01, Z68.41 Coding/Billing Rationale No evaluation and management (E/M) code was added because there was no significant and/or separate identifiable reason for an E/M service to be billed with this scheduled visit for her series of injections. The joint injection was billed with ultrasound guidance due to…
Coding Corner Question: Billing for Joint Injection within a Series
A 68-year-old female Medicare patient with a diagnosis of primary osteoarthritis of the left knee returns to a practice for her third injection in a series of knee injections. She reports being able to resume her after-dinner walks, which last for 30–40 minutes at least twice weekly. She denies fevers or any rashes. She has…
The Rheumatology Research Foundation Honors 153 Award Recipients
CHICAGO—In October, the Rheumatology Research Foundation recognized 153 award and scholarship recipients at an awards luncheon, held in conjunction with the 2018 ACR/ARHP Annual Meeting. The annual event celebrates the accomplishments of rheumatology professionals who have received funding from the Foundation. In congratulating the award recipients, Foundation President Abby Abelson, MD, emphasized the impact the…
Reminder: How to Handle Part D Prior Authorization Requests
Note: Although originally posted in January 2018, the advice below remains valid. We see this issue recur each year. As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B,…
Coding Corner Answers: Rheumatology Word Search
Take the challenge. Ultrasound guidance: There must be a permanent picture placed in the patient’s medical chart to meet the requirements of documentation guidelines. Arthrocentesis: This is the proper term for the withdrawal of fluid and/or injection of medication into a joint. If both the aspiration and injection are performed during the same encounter, only…
Coding Corner Questions: Rheumatology Word Search
Find the words/terms suggested by the following clues: What is the procedure conducted when a permanent picture is required for a joint injection? What is another name for a joint injection? What should be done when a patient returns for an infusion and a prior authorization has already been approved? On what body system is…
Common Issues That Lead to Claim Denials
In an already complicated reimbursement landscape, claims denials can potentially pose a serious issue to the financial revenue for rheumatology practices. Denials are not only highly prevalent in the healthcare environment, but also costly to appeal, which affects overall reimbursements. According to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting…
Rheumatology Research Foundation Names Honorary Board of Advisors
The Rheumatology Research Foundation’s Honorary Board of Advisors is reserved exclusively for individuals who have made a transformative contribution, via a significant donation or through leadership, leaving an indelible mark on the organization’s future fundraising success. This year, Audrey M. Nelson, MD, from the Mayo Clinic, and ACR Executive Vice President Mark Andrejeski were named…
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