It’s time to prepare for 2019 MIPS reporting via the Rheumatology Informatics System for Effectiveness (RISE) registry, and the ACR is here to help. To ensure you’re ready to submit your data to the Centers for Medicare & Medicaid Services (CMS), RISE users should take the following steps: Review your data in the dashboard; Make…
Reimbursement Options for Services Without Direct Patient Contact
Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…
3 Tips for Financial Discussions with Patients
Issues related to the costs and insurance coverage associated with rheumatologic care can be complex and overwhelming for patients. Here’s how one private practice addresses the financial side of treatment with its patients…
Coding Corner Answers: Navigating Medicare’s Online Resources
Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…
Coding Corner Questions: Navigating Medicare’s Online Resources
A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…
How to Navigate & Manage Insurance Overpayments
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…
Google Signs Healthcare Data & Cloud Computing Deal with Ascension
(Reuters)—Alphabet Inc.’s Google signed its biggest cloud computing customer in healthcare yet, according to an announcement on Monday, gaining with the deal datasets that could help it tune potentially lucrative artificial intelligence tools. The Wall Street Journal earlier reported Google teaming up with Ascension to collect personal health-related information of millions of Americans across 21…
Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…
Coding Corner Question: An Insurance Billing Quiz
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…
Why You Should Consider Adding a Dietitian to Your Team
A patient with rheumatoid arthritis (RA) asks if diet can help ease their symptoms. Or maybe a patient with severe knee osteoarthritis (OA) seeks diet advice because they want to lose weight and relieve pressure on their joints. Although there’s no specific nutrition plan for patients with rheumatic diseases, research has shown many dietary factors…
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