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From the College

CMS Repeals Documentation Guidelines for Teaching Physicians

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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

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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

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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…

Tools & Training from the ACR Practice Management Team

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The ACR Practice Management Department actively works to provide valuable, accessible resources addressing practice issues on a local and national level to rheumatologists and their staff. Our trained professionals are devoted to providing the most up-to-date tools and resources to help improve practice efficiency while meeting the myriad compliance obligations of the ever-changing healthcare landscape….

Rheumatology Coding Corner Answer: Bilateral Knee Injections

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Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a…

Rheumatology Coding Corner Question: Bilateral Knee Injections

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A 68-year-old male patient returns to the office for his scheduled bilateral knee injections for primary osteoarthritis. The patient rates the pain in his right knee at an 8 on a scale of 10, and the pain in his left knee at a 7. He was in the office a week before, but the practice…

Charity Navigator Gives Rheumatology Research Foundation Top Rating

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Charity Navigator, America’s largest and most-utilized independent evaluator of charities, has awarded the Rheumatology Research Foundation its ninth consecutive 4-star rating. The prestigious 4-star rating is the highest possible rating given and is based on good governance, sound fiscal management and commitment to accountability and transparency. “The Rheumatology Research Foundation is proud to receive this…

Health Plans Enact Coverage Policies for Remicade & Infliximab Biosimilars

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Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…

Patients Have No More Skin to Give: Dr. William Harvey Testifies on Rheumatology Issues before Senate Committee

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Prior authorization treatment delays, the preferred status conferred on some drugs by pharmacy benefit managers and exorbitant co-payments were among the issues brought before the U.S. Senate Special Committee on Aging on Wednesday, Feb. 7. William F. Harvey, MD, MSc, FACR, a practicing rheumatologist at Tufts Medical Center in Boston and volunteer on the ACR…

How to Avoid Insurance Denials for Prescribing a Biologic Without MTX in Concert

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The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…