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.
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…
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.
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 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.
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.
On Sept. 13, the ACR and Kevin D. Deane, MD, PhD, presented a proposal to create a new clinical code to recognize a condition in which an individual may exhibit rheumatoid arthritis-related autoantibodies without clinical presentation.
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
It’s 11 a.m. on a Wednesday. You see a new patient in your fellow’s clinic with impressive physical findings, including a prominent skin rash and deforming arthritis. The patient has been to many doctors and is frustrated that her condition remains undiagnosed and untreated. You thoroughly examine the patient, present her case to your attending…
Cigna will not move forward with changes to their reimbursement policy for evaluation and management (E/M) codes submitted with modifier 25 as originally scheduled.