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UHC Announces New Copay Accumulator Policy Affecting In-Office Treatments

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Editor’s note Nov. 23, 2020: As of Nov. 12, 2020, UHC has delayed implementation of the policy discussed below. See “UnitedHealthcare Delays Copay Accumulator Policy.” UnitedHealthcare (UHC) announced that, as of Jan. 1, 2021, providers will be required to report the amount their patients receive in copay assistance for office-administered treatments. UHC will then use…

Ethics Forum: The Ethical Considerations of Prior Authorization

Christina Schutt, DO, FAAP  |  

The mother of a 15-year-old patient with juvenile idiopathic arthritis/enthesitis-related arthritis (JIA/ERA) called the office in tears. She said she was having an insurance problem. Her son had been a star track athlete when he developed severe back pain. Magnetic resonance imaging showed evidence of severe sacroiliitis. He was started on a tumor necrosis factor…

Measuring & Preventing Diagnostic Errors

Richard Zamore, MD, MPH  |  

In a December 2019 editorial in the Journal of the American Medical Association, the implications of diagnostic error were explored through the story of two parents, both medical professionals, who sought a diagnosis for their sick child.1 Their son saw specialist after specialist and underwent repeated procedures, but for years was left without an explanation…

2021 Merit-Based Incentive Payment System Payment Adjustments, Explained

Allison Plitman  |  

Many clinicians are receiving smaller reimbursements than expected for their 2021 Merit-Based Incentive Payment System adjustments. Available funding is extremely limited due to the high number of clinicians who were unable to report 2019 MIPS data and accepted the automatic neutral payment under the extreme and uncontrollable circumstances policy.

Guidance Coming for Anticipated COVID-19 Vaccine

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What to vaccinate for and when to do so are challenges for rheumatologists and rheumatology professionals under normal circumstances. During the COVID-19 pandemic, even more questions are being raised, specifically regarding a possible vaccine for SARS-CoV-2. The ACR’s COVID-19 Practice and Advocacy Task Force is working on a guidance document to help ACR members address these pressing questions.

How to Create a Safe Practice & Prep for a COVID-19 Resurgence

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For many months, the healthcare world has been significantly affected by the swift and per­vasive effects of SARS-CoV-2, which causes COVID-19. The virus has severely affected the delivery of patient care by all providers, including those in hospitals and emergency care settings, who grappled with the response to massive influxes of COVID-19 patients, and those…

9 Steps to Transform Your Rheumatology Practice

Erin Arnold, MD; William Arnold, MD; Gary Crump, MD; David Sikes, MD; Drew Johnson, MS, MBA; & Timothy Harrington, MD  |  

The ACR position statement on access to care proposes the goal that “… all patients have timely access to expert rheuma­tology care … .”1 The reality is that new and established rheumatology patient wait times are often prolonged, causing delays in necessary diagnosis and treatment. The 2005 and 2015 ACR Workforce studies document intractable and…