Take the challenge. D. When an infusion is ordered by the provider, there should be a signed order from the provider. If a prior authorization is needed, it should be obtained, with the number of infusions, along with the start and end dates of the authorization. Also, a prior authorization does not guarantee reimbursement; an…
Coding Corner Questions: An Office Personnel Quiz
A 65-year-old male patient diagnosed with rheumatoid arthritis at multiple sites without rheumatoid factor has been ordered to have infliximab infusions. What should support staff do to ensure this procedure can be given to the patient? Make sure there is a signed order from the provider Make sure a prior authorization is obtained Make sure…
Analysis of National & Local Coverage Determinations
The Medicare statute states that items and services provided to beneficiaries must be “reasonable and necessary” to qualify for reimbursement. Although the Medicare program determines in specific cases whether an item or service is reasonable and necessary, it also issues policies, called coverage determinations, to instruct Medicare Administrative Contractors (MACs) what to reimburse providers for….
Commercial Insurers Extend Coverage for Telehealth Services
The ACR has created a chart of temporary changes to commercial payers’ telehealth policies that make it easier for physicians and patients to connect without the need for an office visit.
Experts Discuss Current Insurance Issues Challenging Rheumatology
ATLANTA—From step therapy requirements to infusion center locations to evaluation and management coding, insurance issues bring frequent headaches to clinicians and patients. Experts discussed some of the most recent concerns in a session at the 2019 ACR/ARP Annual Meeting. Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee (ISC), and Gary Bryant, MD, delegate to…
Timothy Laing, MD, Reappointed to AMA’s Relative Value System Update Committee
Timothy Laing, MD, will continue to represent the ACR in his third stint on the AMA’s Relative Value System Update Committee, helping determine the relative value of clinical services.
Coding Corner Answers: Using NP/PA Services in Practice
Take the challenge. Scenario 1—A: The nurse practitioner may act as the supervising physician if it’s within the scope of practice for the NP and should be coded as follows: CPT: 96413, 96415, J1745 x 30, J1200 x 1 Diagnosis ICD:10: M05.79 Scenario 2—A: To qualify as an incident-to service, the PA can provide the…
Coding Corner Questions: Using NP/PA Services in Practice
Scenario 1: Direct Billing A 70-year-old female patient with rheumatoid arthritis in multiple joints and positive rheumatoid factor returns to the practice for her fourth infusion of infliximab with the nurse practitioner (NP). She reports no fevers, cough, dyspnea or concurrent illness. She rates the severity of her joint pain at 6 on a 10-point…
Don’t Miss 2020 E/M Coding Workshop in New Orleans
Access to good training and education on practice management and coding issues has proved beneficial to physician success. Getting up-to-date information on compliance, insurance reimbursement, office efficiency, coding and billing is crucial for effective and efficient practice management. The ACR’s Committee on Rheumatologic Care (CORC) has created the premier one-day E/M Documentation Trends and Best…
Coverage & Reimbursement Challenges: Updates from the ACR Insurance Subcommittee Chair
The ACR Insurance Subcommittee is working to address specialty pharmacy requirements for in-office treatments, elimination of consultation codes and other coverage and reimbursement challenges.
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