Beginning in June 2018, UnitedHealthcare (UHC) will implement their risk adjustment data validation (RADV) audit program. UHC states that through the mandatory requirement by the U.S. Department of Health and Human Services (HHS), Medicare Advantage health plans will be reviewed for supporting medical documentation to check for accurately reported patient data. UHC will send requests…
Avoid Errors: Insights into Ensuring Accurate Data in EHRs
With the increasing use of electronic health records and quality measure reporting requirements, data collection has become crucial for rheumatologists. But how do clinicians prevent human error and ensure data accuracy?
Avoid Billing Risks for New vs. Established Patients
When coding evaluation and management (E/M) services provided to a patient, one of the most persistent concerns is whether a patient is new or established to the practice. Although this may seem like a simple coding answer, the distinction is an important one, because it enables providers to appropriately bill and receive reimbursement correctly. E/M…
Rheumatology Coding Corner Answer: Billing for an Inflectra Infusion
Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…
Rheumatology Coding Corner Question: Billing for an Inflectra Infusion
A 68-year-old female patient returns to the office for a second round of Inflectra (infliximab-dyyb) infusion for her rheumatoid arthritis with rheumatoid factor of multiple joints without organ or systems involvement. She reports pain, stiffness and swelling in her left and right knees and right elbow and rates the pain at a 9 on a…
3 Ways to Improve How You Work with Doctors from Other Specialties
Many trainees tell me they’re attracted to rheumatology because it demands becoming a complete physician. We need knowledge of the brain, eye, lung, kidney, liver, skin, bones and vascular system to be effective rheumatologists. And because our diseases are frequently multisystem diseases, rheumatologists must be the quintessential collaborators. For more than 30 years, I’ve directed…
The Social Workers’ Role in Rheumatology Care & Patient Advocacy
Patients with rheumatic disease require a team of specialists working together to meet the patient’s needs. Social workers can advocate for these patients and play a variety of other roles to help them manage their disease…
CMS Releases 2018 MIPS Eligibility Tool
You can now use the updated CMS MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-Based Incentive Payment System (MIPS). Enter your National Provider Identifier (NPI) in the tool to find out whether you need to participate during the 2018 performance year. Changes to Low-Volume Threshold To reduce the burden on…
New Compounding Regulations could Adversely Affect Rheumatologists, Patients
On July 28, 2018, the USP will publish preliminary updates to existing drug compounding standards that could affect whether rheumatologists maintain the ability to mix, combine or otherwise customize medications in office for individual patient use. The ACR, in concert with the American Medical Association (AMA) and others, is working to help ensure rheumatologists can…
Clinical Remission Should Be Target of JIA Treatment: Task Force
NEW YORK (Reuters Health)—An international task force says patients with juvenile idiopathic arthritis (JIA) should be treated to a target of clinical remission, among other new recommendations. “The Task Force is convinced that transferring (the recommendations) into clinical practice will significantly improve the outcomes in patients with JIA,” Dr. Angelo Ravelli of the Istituto G….
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