Each fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) puts out its Work Plan for the upcoming fiscal year to summarize its initiatives and priorities for new and ongoing work of HSS programs. Below is a summary of the key areas the OIG will focus on in 2017: Drug…
The ACR Asks Congress to Dedicate Arthritis Research Funding to Help Military Service Members
In 2016, the ACR and the Arthritis Foundation teamed up to direct $20 million within the Department of Defense’s (DoD’s) Congressionally Directed Medical Research Program (CDMRP) to arthritis treatment and prevention. The CDMRP has millions of research dollars that have not been committed to specific items. In the new appropriations cycle, we are once again…
Rheum Life Campaign Shares Patients’ Perspectives on Life with Rheumatic Disease
As part of the Rheumatology Research Foundation’s Visibility Initiative, the Rheum Life campaign was developed as a way to share a patient’s perspective of what life is like with a rheumatic disease. Rheum Life also provides insight into current Foundation-funded research and the impact it will have on the lives of these patients. Exposure to…
ACR Hosts Arthritis 101 Briefing on Capitol Hill
On Jan. 31, the ACR partnered with the Arthritis Foundation to host an Arthritis 101 Congressional briefing on Capitol Hill. Panelists educated new and returning members of Congress and their staffers about arthritis and other rheumatic diseases, the cost and impact of rheumatic disease to constituents and the U.S. healthcare system, and current policy challenges…
Reminder: How to Handle Part D Prior Authorization Requests
As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B, but when it’s used as an oral agent for rheumatoid arthritis, it’s covered by Part D. Early in the…
Rheumatology Coding Corner Answer: Coding for a Knee Injection
CPT: 20611-LT, J7325 X 1 ICD-9: 715.16—Osteoarthritis, localized, primary, lower leg ICD-10: M17.12—Unilateral primary osteoarthritis, left knee Note: When billing for 20611—Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa), with permanent recording and reporting, there must be a permanent photograph of the needle placement in the patient’s medical chart….
Rheumatology Coding Question: Deconstructing Evaluation and Management Codes
A 50-year-old male patient returns to the office for a follow-up visit for a diagnosis of generalized primary osteoarthritis of multiple sites. The patient tells the medical assistant that he is experiencing sharp throbbing pain in his left hip and right and left knees. He states the pain level is 6 out of 10 and…
The ACR Insurance Subcommittee Advocates for Fair Payer Policies
The ACR is committed to advocating for appropriate coverage and payment policies. The volunteer members of the Insurance Subcommittee (ISC) lead this effort by representing the ACR and its membership to the insurance industry. The ISC engages payers to ensure their policies are clinically appropriate and promote patient access to high-quality care and treatment. The…
RheumPAC Contributions Needed in 2017 to Educate Federal Policymakers about Rheumatology Concerns, Interests
2016 was an impactful year for ACR advocacy efforts. Last month we reviewed our advocacy accomplishments in 2016, accomplishments that benefited 100% of our members. However, more than 95% of ACR and ARHP members had not invested in RheumPAC by the conclusion of the 2016 ACR/ARHP Annual Meeting. Each year, many of the same dedicated…
Rheumatology Coding Answer: Deconstructing Evaluation and Management Codes
Take the challenge. Answers: B: No—Only the treating physician can take the HPI. The medical assistant is allowed to take the review of systems. If the documentation indicates the treating physician did not take the HPI, the insurance can deny the claim as not medically necessary. B: No—If the high-risk medication is not assessed and…
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