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.
September Updates from the ACR Insurance Subcommittee
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.
Ethics Forum: Billing, Burnout and Protected Non-Clinical Time
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 Delays Modifier 25 Policy Change for Evaluation & Management Services
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.
New HCPCS Code Added for Anifrolumab-fnia, 1 mg
Effective for dates of service on or after April 1, the Healthcare Common Procedure Coding System (HCPCS) code J0491 is valid for billing 1 mg anifrolumab-fnia.
New No-Surprises Rules May Affect Rheumatology Services at Hospitals
This month, we offer an overview of the federal No Surprises Act, which stipulates that healthcare insurers may not surprise patients with out-of-network care bills, instead requiring healthcare providers and insurers to broker price compromises between themselves. The No Surprises Act, enacted on a bipartisan basis in December 2020, protects patients from surprise billing from…
The ACR Seeks Trainees for AMA/Specialty Society RUC & CPT Committees
Advisors of the American Medical Association (AMA) Current Procedural Terminology (CPT) and Relative Value Update (RUC) Committees play a crucial role in the code creation and valuation process. These positions allow the ACR to have a significant voice in influencing changes and ensuring rheumatology services are effectively represented.
Get Expert Advice on Compliance Safeguards Post-Pandemic
Payer audits and coding scrutiny are in full swing after an influx of fraudulent claims during the COVID-19 pandemic. Make sure your coding practices are in compliance to protect your revenue.
Key 2022 Coding & Billing Updates
In 2022, rheumatology practices should prepare for documentation, coding, billing and reimbursement revisions related to evaluation and management (E/M), split/shared billing policies and telehealth services.
Defining Administration Complexity by the Drug, Not the Diagnosis
Enabling rheumatology practices to use complex administration codes for biologic drugs is critical for maintaining patient access to essential therapies.
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