Elected officials and government entities make decisions every day that directly affect your practice and ability to treat patients. Although the ACR continues to be your eyes and ears in Washington, D.C., often the most effective agents of change are citizens, like you, who get involved in the legislative process. It’s easy to be an…
Rheumatology Coding Corner Answer: Follow-Up Knee Injection
Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale CPT Codes: 20610-LT, J7325x16 ICD-10 Code: M17.12 This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In…
Rheumatology Coding Corner Question: Follow-Up Knee Injection
On Nov. 4, a 55-year-old female patient presents to the office for a follow-up visit for injection of the left knee for osteoarthritis. This is her third of three injections that were preauthorized through Oct. 31. She reports pain and swelling in her left knee and rates the pain at an 8 on a 10-point…
5 Steps to Help You Manage Prior Authorizations
Despite continuous movement to streamline the prior authorization process, physician practices are still struggling with jumping through hoops to have procedures and medications covered. A prior authorization (PA) is the process insurance carriers have in place to approve or reject prescriptions based on plan formulary. The PA process is important in ensuring appropriate and cost-effective…
The ACR’s 2018 Legislative & Regulatory Priorities
A recent Politico article outlined the looming agenda facing Congress as 2018 begins: Fund the government, raise the debt ceiling, modify spending caps, address healthcare subsidies, allocate additional funds for disaster relief, and address the status of millions of undocumented young immigrants.1 Amid all that activity, the ACR, through its Government Affairs Committee (GAC) and…
Providers Using RISE Have Advantage with 2017 MIPS Reporting
Hundreds of rheumatology providers across the country are finalizing submissions for the first year of reporting under the Merit-Based Incentive Payment System (MIPS). According to a presentation at the 2017 ACR/ARHP Annual Meeting in San Diego, providers that participate in and submit through the Rheumatology Informatics System for Effectiveness (RISE) Registry are poised to perform…
Back to the Future: Spotlight on ACR Past President Dr. Herbert Kaplan
We are sad to report that Dr. Kaplan passed away on Saturday, June 23. We are reposting this story now to celebrate his life.
CMS Repeals Documentation Guidelines for Teaching Physicians
As of March 5, physicians no longer have to write their own notes in addition to notes created by students, residents or fellows during patient examinations; instead, providers will only have to verify information documented by the student. Early last month, the Centers for Medicare and Medicaid Services (CMS) reversed the Obama administration policy that prohibited…
Participate in CMS Reporting Study to Receive 2018 Improvement Activity Credit
The Centers for Medicare & Medicaid Services (CMS) is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC). The CMS is conducting this study to: Examine clinical workflows and data-collection methods using different submission systems; Understand the challenges clinicians face when…
Anthem Cancels Planned Modifier 25 Cuts
Anthem, a Blue Cross Blue Shield company that operates in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia and Wisconsin, has decided not to move forward with a policy that would have resulted in decreased reimbursement for evaluation and management (E/M) services when billed with modifier 25. As reported…
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