The 2019–2020 legislative cycle in the states holds real hope and opportunity for critical reforms to protect rheumatology practices and patients. It is important to note that because of the state legislative process, bill passage almost always comes later in the legislative session. Although the rheumatology community has not yet seen many official wins, early…
Coverage Requirements for HLA-B27 Vary by Testing Methodology
Did you know a laboratory can perform one of two different tests when a provider orders an HLA-B27 blood test? The ACR Insurance Subcommittee has received several complaints regarding commercial payer coverage for these tests, depending on which methodology the lab employs. To avoid administrative burden, members should familiarize themselves with lab practices and payer…
Coding Corner Answer: A Quiz on Modifiers
Take the challenge. 1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is…
Coding Corner Question: A Quiz on Modifiers
Which modifier is used when there is a separate and/or identifiable reason to bill for both an evaluation and management code and a procedure code? -25 -24 -51 -59 Which modifier is used to indicate that bilateral procedures were done on a patient? -50 -LT/RT Both a and b None of the above A 68–year-old…
Advocacy in Action: How the ACR Is Working for You
Out of the turmoil of 2018 came a number of significant victories for the rheumatology field, all of which are thanks to the ACR’s volunteers, who spearheaded communication with policymakers. We are thrilled to share these successes and look forward to working with you in an even more productive 2019 (view this larger on our…
Rheumatology Research Foundation Fuels Pipeline of Next-Gen Providers
One aspect of the Rheumatology Research Foundation’s work is recruiting more people into the field, and it starts by building interest in rheumatology among the best and brightest medical and graduate students. The Foundation is fueling the pipeline of rheumatology professionals by supporting students, residents and fellows in a number of ways, such as with…
Quinacrine Shortage & What the ACR Is Doing about It
The FDA recently conducted an inspection of the only manufacturer that had FDA approval to import quinacrine. Unfortunately, the manufacturer did not pass inspection and was put on an import alert. This effectively shuts down any importation of quinacrine to the U.S. until the manufacturer goes through the necessary steps to be re-inspected or until…
Possible MIPS Errors in 2019 Payment Adjustment
Recently, the Centers for Medicare and Medicaid Services (CMS) discovered an error in the implementation of the 2019 Merit-Based Incentive Payment System (MIPS) payment adjustment. It incorrectly applies adjustments to payments for Medicare Part B drugs and other non-physician services billed by physicians. Adjustments to affected claims will occur in the near future. According to the…
Update & Changes to the OIG Work Plan
Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity….
Rheumatology Board Certification: Exploring Change
The ACR has been engaged in a measured, inclusive process with rheumatologists to determine if rheumatology board certification should move from the American Board of Internal Medicine (ABIM) to the American Board of Allergy and Immunology (ABAI), which would become a new, combined board of Allergy, Immunology and Rheumatology. “As ACR leaders have traveled around…
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