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…
How to Improve Opioid Prescribing in an Outpatient Clinic
More than 72,000 Americans died from opioid overdoses in 2017, according to the National Institutes of Health.1 The impact of the opioid epidemic has affected many levels of patient care and, as a result, healthcare systems are responding to escalating death rates, new legislation and the possibility of compromised patient safety in a multitude of…
How to Improve Rheumatologist-Hospitalist Communication & Access
The traditional model for subspecialist consultations on hospitalized patients by outpatient-based rheumatologists may seem straightforward. Hospitalists (the inpatient specialists who now manage most in-hospital medical care in the majority of U.S. hospitals) typically call upon the rheumatologist’s expertise for joint swelling and a rash or fever of unknown origin, says Lianne Gensler, MD, of the…
Using RISE Data in Research
The ACR’s RISE registry offers answers on real-world experience to researchers.
Annual Meeting Preview: Maximizing Reimbursement Under MACRA, MIPS & APMs
A session at the 2019 ACR/ARP Annual Meeting will help rheumatologists navigate current payment systems and identify resources to ensure appropriate reimbursement for complex care.
An Interview with ACR Honoree Rep. Raul Ruiz on Step Therapy Reform
Rep. Raul Ruiz co-introduced the Safe Step Act in April and has helped educate members of Congress about how step therapy hurts patient outcomes and care.
ACR Leads Coalition Opposing Cigna’s Elimination of Consultation Codes
In a letter co-signed by other Cognitive Specialty Coalition organizations, the ACR is requesting at least a one-year delay to better coordinate payer changes with recent federal initiatives.
UnitedHealthcare Delays Policy Changes Affecting Physician-Administered Treatments
Changes announced at the beginning of October have now been delayed for Actemra, Benlysta, Cimzia, Orencia and Simponi Aria, but changes to the Stelara policy remain in effect.
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