An error in UnitedHealthcare’s claims processing system resulted in underpayments on J code claims dated Oct. 8–Nov. 8, 2023. Practices are encouraged to review all J code payments from the final quarter of 2023.
ACR Advocates with Payers Against Insufficient Reimbursement for Biosimilars
The ACR is engaging with payers regarding formulary requirements that would leave practices underwater when treating patients with rheumatic diseases.
Ask Congress to Support Complexity Add-on Code
Implementation of the G2211 add-on code for evaluation and management services is included in the CY 2024 Medicare Physician Fee Schedule, barring further delays. Ask your lawmakers to support timely implementation and patient access to complex care.
We Want You: Your Role in the CPT Valuation Process
Accurate reimbursement for rheumatology services ensures rheumatologists can run successful practices and provide needed care, but only if they speak up through survey input to explain how much that care costs. Here’s how to participate in the process when rheumatology CPT codes come up for review.
Updates from the ACR Insurance Subcommittee Chair
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices. Recent activities include efforts to avoid increased administrative burden associated with specialty medications, support payer coverage of musculoskeletal ultrasounds and protect patient access to biologics.
Ethics Forum: Thoughts on Managing Electronic Communication with Patients
Recent proposals in the U.S. to bill for electronic communication with our patients could be seen as a refreshing but contested attempt to battle burnout rates in the present era. A fee for electronic communications between patients and clinicians also acknowledges the value of the clinician’s time and expertise. But is this ethical? Discussion Burnout…
The ACR Opposes New AI-Based Decision-Making Platform
On July 1, Blue Cross Blue Shield of North Carolina introduced a machine-learning technology platform to make decisions about patients’ care and treatment. The ACR opposes its use on grounds that it may harm patients’ access to treatment and undermine the doctor-patient relationship.
Copay Accumulator & Maximizer Programs Threaten Access to Treatment
As health insurance companies and third-party benefit managers continue to use copay accumulators and maximizers to shift the cost of specialty drugs to patients, the ACR continues to advocate against programs that limit copay assistance.
After Pushback, Cigna Delays Modifier 25 Policy Changes
After significant pushback from the AMA, ACR and other medical societies, Cigna has delayed implementation of changes to its modifier 25 reimbursement policy, originally scheduled to take effect May 25.
Key Facts on Billing Drug Wastage
The ACR has compiled guidelines and tips on how to use the JW modifier and correctly bill Medicare for discarded drugs and biologicals. This modifier can be applied only to unused amounts from a single-dose vial or package.
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