UnitedHealthcare (UHC) recently proposed two policy changes that would have a negative impact on reimbursement for consultation services and evaluation and management (E/M) services when billed with modifier 25. The effective date for both of these proposed changes is Oct. 1, 2018. Consultation Services Under the proposed consultation codes policy, UHC would end reimbursement for…
The ACR/CHEST ILD Guidelines in Practice, a video
In collaboration with the American College of Chest Physicians, the ACR released two new comprehensive guidelines aimed at improving the screening, monitoring, and treatment of patients with interstitial lung disease (ILD) secondary to systemic autoimmune rheumatic diseases (SARDs). Recently, Sindhu R. Johnson, MD, PhD, professor of medicine at the University of Toronto, Canada, director of the Toronto Scleroderma Program and principal investigator for the guideline, and Elana J. Bernstein, MD, MSc, Florence Irving associate professor of medicine in the Division of Rheumatology at Columbia University, New York City, and co-first author, presented a webinar to talk about how the guidelines were developed and present some of the recommendations and their rationale: Watch the recording now!
Pennsylvania Rheumatology Society Engages Multiple Generations
Two years ago, veteran leaders of the Pennsylvania Rheumatology Society (PRS)—established 20 years prior—made an important decision to get early career rheumatologists more involved. “We thought younger rheumatologists were under-represented, and we wanted to give them a voice [so they would] better understand a wider range of practice issues our society could address,” explains Alfred…
ACR & NPF Highlight Medicare Access Challenges in Capitol Hill Briefing
Concerns about how the Trump administration’s ideas to lower drug prices could reduce patient access to medicines led the ACR to speak out on many different fronts. On June 25, at a briefing hosted by the ACR and the National Psoriasis Foundation (NPF), a packed room of Congressional staffers and reporters learned from rheumatologists and…
Program May Prevent Work Loss for Patients with Rheumatic Diseases
Within 10 years of diagnosis, 23–45% of patients with rheumatic and musculoskeletal disease may become unemployed due to disease-related disability. Intervention programs may be necessary to prevent this work loss. New research examined if a vocational rehabilitation program delivered by occupational and physical therapists can benefit this patient population…
Pain Links Fibromyalgia & RA
Many patients with rheumatoid arthritis (RA) report pain despite excellent control of inflammation with immunotherapies. Variable degrees of coexisting fibromyalgia (FM) may explain this disparity. RA patients who have the highest 2011 ACR FM survey criteria scores appear to share neurobiologic features consistently observed in FM patients. This study is the first to provide neuroimaging evidence that RA is a mixed pain state, with many patients’ symptoms being related to the central nervous system rather than to classic inflammatory mechanisms…
ACR’s 2018 Advocates for Arthritis & Advocacy 101 Program
On Sept. 23–25, the ACR will once again hold its annual Advocates for Arthritis fly-in event in Washington, D.C. Held in conjunction with the ACR’s Advocacy 101 course, the fly-in is a great way for members and their patients to learn about issues important to the practice of rheumatology and have the opportunity to actively…
ACR Responds to Drug Pricing Proposals
Responding to the Trump administration’s drug pricing proposals, the ACR released a set of principles it hopes will help guide any drug policy changes.1 The principles underscore what is critically needed for rheumatologists to provide the best and safest care to their patients, many of whom require ongoing treatment for chronic conditions. “The ACR has…
AMA House of Delegates 2018 Annual Meeting Recap
On June 8–13, the AMA House of Delegates (HOD) came together in Chicago for its 2018 Annual Meeting. With the recent change in apportionment of geographic and specialty delegates now equal to each other, more than 600 members of the HOD were present, with several hundred staff and attendees from the AMA and other medical…

ACR/ARHP Advocacy Leaders Lobby U.S. Congress
On May 16 and 17, ACR/ARHP leaders serving on the Board of Directors, Affiliate Society Council, Government Affairs Committee, Committee on Rheumatologic Care, RheumPAC Committee and Insurance Subcommittee once again went to Capitol Hill to advocate on behalf of ACR/ARHP members and their patients. The group represented 27 states and the District of Columbia, and…

Different Payer Audits Require Different Preparation & Response
For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…
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