As of Oct. 1, UnitedHealthcare (UHC) requires that patients fail to respond to both FDA-approved rituximab biosimilars prior to receiving approval for rituximab. Exception: Rituximab-pvvr (Ruxience) is not FDA approved for rheumatoid arthritis.
ACR Convergence 2020 Workshop Covers 2021 Practice Management & Coding Changes
Attendees at the daylong workshop will learn about key evaluation and management code changes coming in 2021 that affect rheumatologists and rheumatology professionals.
Bring Quality Measures into Focus at ACR Convergence 2020
A panel of rheumatologists will provide updates on MACRA’s quality measure requirements and the ACR’s progress in quality measurement in rheumatology in a session at ACR Convergence 2020.
Hardship Exception Applications Open for Clinicians Struggling with Quality Payment Program Reporting in 2020
The Centers for Medicare & Medicaid Services have provided the opportunity to apply for exceptions for the Performance Year (PY) 2020 Quality Payment Program Merit-Based Incentive Program (MIPS) program requirements. This will help clinicians finding PY2020 MIPS federal reporting difficult due to circumstances outside their control.
UHC Announces New Copay Accumulator Policy Affecting In-Office Treatments
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…
ACR Urges Commercial Payers to Cover Telemedicine Beyond the Public Health Emergency
In a letter sent to commercial payers, the ACR’s Insurance Subcommittee is advocating for continued coverage for telemedicine, including reimbursement parity, after the end of the declared public health emergency.
Changes in ICD-10 for Sjögren’s Syndrome
A code change in the ICD-10 classification for Sjögren’s syndrome was approved by the ICD-10 Coordination and Maintenance Committee in July 2019 and becomes effective October 2020.
Providers & Patients Talk to Legislators about Telehealth, Workforce Shortage
On Sept. 15, rheumatology advocates met virtually with members of Congress to share personal accounts of how telehealth is making a difference during the COVID-19 pandemic and what will help stem a workforce shortage.
Ethics Forum: The Ethical Considerations of Prior Authorization
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…
Best Practices for COVID-19 Regulatory Waivers, Relief Funding & Audits
When the first laboratory-confirmed COVID-19 case was reported by the Centers for Disease Control & Prevention (CDC) on Jan. 22, it was difficult to predict an ensuing global pandemic would last for more than half the year. Approximately one week after the initial CDC report, the U.S. Department of Health & Human Services (HHS) declared…
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