Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a new prior authorization model called the Wasteful and Inappropriate Services Reduction (WISeR) Model. This six-year model, starting on Jan. 1, 2026, aims to reduce fraud, waste and abuse in traditional Medicare by using technology-enabled processes for prior authorization and…
Stay Current on Coding Guidelines with ACR Lunch-and-Learns
Available topics include CPT telemedicine code sets, G2211 coding updates, evolving HIPAA guidelines, evaluation and management (E/M) coding and billing strategies.
After Coalition Meeting, CMS Leadership Agrees to Closer Look at Underwater Biosimilars
The Underwater Biosimilars Coalition shared with the Centers for Medicare & Medicaid Services concerns about problems arising from the average sales price payment methodology and discussed potential options for addressing these challenges.
ICD-10 CM Overview & Updates for 2025
The newest ICD-10 code set went into effect on Oct. 1 and includes more than 400 new and revised diagnosis codes and headers. In September, the ACR also proposed a new diagnosis code that will undergo a public comment period and consideration for inclusion in a future update.
ACR-Led Coalition Working Toward Legislative Solutions for Underwater Biosimilars
The Underwater Biosimilars Coalition will meet with the Medicare Payment Advisory Commission to discuss concerns about inadequate reimbursement for certain biosimilars, which has limited beneficiary access to these lower-cost alternative therapies.
ACR-Led Coalition on Underwater Biosimilars Grows, Charts Next Steps
New members include rheumatology state societies, specialty partners in gastroenterology and patient-facing organizations representing digestive and inflammatory diseases. The ACR and coalition partners are strategizing additional steps to ensure practices receive adequate reimbursement for biosimilars.
Methylprednisolone & Methotrexate: Codes & Billing Updated
As of April 1, HCPCS codes for methylprednisolone have changed. The ACR is working with the CMS to determine how rheumatologists should bill Medicare corrrectly.
Congressional Action Partially Addresses Medicare Cuts
The newest funding package reduces the latest cut to Medicare reimbursement from 3.4% to 1.68%. Although rheumatologists are faring better under Medicare in 2024, broader reforms remain the ACR’s highest priority regarding Medicare payments to physicians.
Updated Coding Guidance for 2024 Remote Physiologic Monitoring & Therapeutic Monitoring
The Centers for Medicare & Medicaid Services updated recent regulations to clarify some points about remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services for key areas.
ACR Offers Lunch-and-Learn Series on Coding & Compliance for G2211
A free, tailored, one-hour series on coding and compliance for G2211 will help rheumatology practices bill correctly with the new add-on code to maximize reimbursements and minimize claim denials or rejections.
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