A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…
Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…
Coding Corner Question: An Insurance Billing Quiz
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…
ACR Leads Coalition Opposing Cigna’s Elimination of Consultation Codes
In a letter co-signed by other Cognitive Specialty Coalition organizations, the ACR is requesting at least a one-year delay to better coordinate payer changes with recent federal initiatives.
ACR Fights Cigna Decision to Eliminate Consultation Codes
As of Oct. 19, Cigna will deny claims billed with codes for consultation services, making it the second payer to discontinue payment for evaluation and management codes in 2019.
Coding Corner Answer: Is This Shoulder Ultrasound Billable?
Take the challenge. Answer: No, if billed as incident-to for the NP. Note: The patient’s current insurance carrier is Blue Cross Blue Shield of Massachusetts (BCBS of MA). Under BCBS of MA, nurse practitioners and nurse practitioner primary care providers are not allowed to perform or interpret radiology services. Therefore, the physician would have to…
Coding Corner Question: Is This Shoulder Ultrasound Billable?
A 32-year-old male patient with rheumatoid arthritis affecting multiple joints without rheumatoid factor returns to the office for a follow-up visit with the nurse practitioner (NP). The patient states his overall pain has improved since his previous visit, although he rates the severity of his right shoulder and right wrist pain at a 5 on…
The Association of Rheumatology Professionals Names Grant Recipients
It is with great pleasure that the ARP congratulates the 2019 recipients of the Mentored Nurse Practitioner/Physician Assistant Award for Workforce Expansion. The purpose of the NP/PA Award is to increase the supply of rheumatology healthcare providers to better meet the needs of people with rheumatic diseases across the U.S., particularly in geographically underserved areas….
Proposed 2020 E/M Codes Include Reimbursement Changes
Increased reimbursement would reflect value of cognitive care and other time-intensive services provided by rheumatologists.
CMS Proposes Major Payment Increases for E/M Services
CMS estimates that under their proposal, released July 29, rheumatologists would see on average a 15% payment increase, beginning in 2021.
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