History A 39-year-old woman returns for follow-up for her rheumatoid arthritis. She has positive rheumatoid factor, but no organ or systemic involvement. She has joint swelling and pain in her left hand, right elbow and right knee. Her pain is at an 8 on a 10-point scale. She states the pain is worse in the…
Physicians have three contractual options when it comes to the Medicare program: participating, non-participating and opting out. Providers should keep the old saying “look before you leap” at the forefront when considering opting in or out of the Medicare program. Since 2001, physician costs have been on the rise, with only minimal increases in reimbursements,…
The Rheumatology Research Foundation has been actively involved with the NIH’s Accelerating Medicines Partnership for Rheumatoid Arthritis and Systemic Lupus Erythematosus (AMP RA/SLE) program, launched in 2014 as a public–private partnership to spur development of new therapeutic options for RA and lupus. Recently, the NIH released new datasets that will help clinical investigators accelerate therapies…
The ACR was part of a 16-member collaboration that created a set of 21 principles on prior authorization and utilization management, intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other healthcare organizations support those principles. Now, the AMA has released the results…
Elected officials and government entities make decisions every day that directly affect your practice and ability to treat patients. Although the ACR continues to be your eyes and ears in Washington, D.C., often the most effective agents of change are citizens, like you, who get involved in the legislative process. It’s easy to be an…
Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale CPT Codes: 20610-LT, J7325x16 ICD-10 Code: M17.12 This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In…
On Nov. 4, a 55-year-old female patient presents to the office for a follow-up visit for injection of the left knee for osteoarthritis. This is her third of three injections that were preauthorized through Oct. 31. She reports pain and swelling in her left knee and rates the pain at an 8 on a 10-point…
Despite continuous movement to streamline the prior authorization process, physician practices are still struggling with jumping through hoops to have procedures and medications covered. A prior authorization (PA) is the process insurance carriers have in place to approve or reject prescriptions based on plan formulary. The PA process is important in ensuring appropriate and cost-effective…
The Rheumatology Research Foundation has appointed Abby G. Abelson, MD, with the Cleveland Clinic to serve as president. She begins a two-year term alongside the new vice president, S. Louis Bridges Jr., MD, PhD, with the University of Alabama at Birmingham (UAB). Drs. Abelson and Bridges are highly accomplished leaders in the field of rheumatology…
Hundreds of rheumatology providers across the country are finalizing submissions for the first year of reporting under the Merit-Based Incentive Payment System (MIPS). According to a presentation at the 2017 ACR/ARHP Annual Meeting in San Diego, providers that participate in and submit through the Rheumatology Informatics System for Effectiveness (RISE) Registry are poised to perform…