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…
Measuring & Preventing Diagnostic Errors
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
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
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.
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