CHICAGO—ACR leaders described a series of looming legislative and regulatory threats to rheumatologists and their patients—including the proposed collapsing of evaluation and management (E/M) coding and potential changes to step therapy rules—and urged everyone in the field to make their voices heard to quash the proposals. They also recounted recent victories in the policy realm…
As of Jan. 1, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement several coding and documentation policies to provide immediate burden reduction to providers. The 2019 Medicare Physician Fee Schedule Final Rule (MPFS) released Nov. 1, 2018, by the CMS contained significant changes to the Medicare Part B coding and documentation policies…
Take the challenge. C—This claim cannot be coded without querying the infusion nurse and physician. There must be documentation of the patient’s weight to document the correct dosage of the medication to be given to the patient. Also the start time and the completion time of the infusion must be documented to know which drug…
A 70–year-old female patient with rheumatoid arthritis affecting multiple joints who is rheumatoid-factor positive but without organ or system failure returns for her third infliximab infusion. She is scheduled to receive 500 mg of the drug. How should this encounter be coded? 96413, 96415, J1745 x 50; ICD 10: M05.79 96413, 96415, J1745 x 50;…
Missed appointments have long been a problem for rheumatology practices. A recent poll from the Medical Group Management Association (MGMA) found no-shows were the single biggest challenge reported by practice leaders, with 44% of respondents citing the issue.1 If a patient does not come to the office when scheduled, it starts a cascade of events…
NEW YORK (Reuters Health)—The proposed collapsing of payment amounts for levels 2 to 5 evaluation and management (E/M) services by the U.S. Centers for Medicare and Medicaid Services (CMS) would have different financial impacts on different specialties, researchers report. “Specialists that tend to have more complicated and/or longer visits would lose money, and specialists that…
Early in her medical school career, Beth Jonas, MD, FACR, was fascinated by the multi-system and chronic nature of rheumatic diseases. The field of rheumatology offered her the chance to make long-term connections with the patients she cares for, and she says her early instincts have led her to a career that has not disappointed….
Both private and academic rheumatology practices face payer challenges that put the health of their patients and their practices at risk. To make sure the rheumatologist perspective is heard by payers, “the ACR’s Insurance Subcommittee (ISC) serves as the interface between payers and our members and ACR colleagues,” explains Sean Fahey, MD, a rheumatologist in…
Gaps in healthcare are common between the ages of 17 and 21. But simple collaborations between adult and pediatric rheumatologists can go a long way to help young adults stay engaged in their rheumatology care…
Unfortunately, prior authorization continues to be a burden for providers, practices, and patients. Effective Jan. 1, 2019, UnitedHealthcare (UHC) will retire fax numbers used for medical prior authorization (PA) requests. After this date, UHC will require PA requests to be submitted through their Prior Authorization and Notification tool. Providers who can’t submit requests electronically may…