A 68-year-old male patient returns to the office for his scheduled bilateral knee injections for primary osteoarthritis. The patient rates the pain in his right knee at an 8 on a scale of 10, and the pain in his left knee at a 7. He was in the office a week before, but the practice…
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
If you have not done so already, you may submit your 2017 MIPS data to the Centers for Medicare and Medicaid Services (CMS) starting today. Log in to your RISE dashboard, click on all the MIPS categories you would like to report through RISE, and then click on the Submit button. The deadline to submit…
(Reuters Health)—A growing number of patients are seeking care from rheumatologists for chronic health problems like arthritis, back pain and osteoporosis, just as the supply of specialists is shrinking, two new studies suggest. An estimated 6,013 clinicians in the U.S. specialized in rheumatology as of 2015, the equivalent of 5,415 full-time providers, according to one…
LATE-BREAKING NEWS Editor’s note: The ACR praises Congressional leaders for passing today’s (2/9) sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauded the inclusion of…
In 2018, all providers will have to submit an entire year’s worth of their quality measure data to the CMS. After 2017, the transition year, the requirements and performance thresholds begin to increase. The CMS is still heavily incentivizing participation in a Qualified Clinical Data Registry (QCDR), such as the RISE registry, for reporting in…
(Reuters)—After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions. Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the U.S.s’ huge over-65 health…
Each year the American Medical Association’s CPT code manual is revised to delete codes and/or guidelines, and to add or revise codes to reflect current technologies, techniques and services. Medicare and all other payers are switching to the new 2018 CPT codes for X-rays of the chest. The original codes for a chest X-ray were…
The Case A 58-year-old patient with knee osteoarthritis has been decreasing her physical activity over the past several years due to painful joints, which has resulted in significant weight gain. At her appointment, you encourage her to engage in more physical activity and eat a well-balanced diet. A few weeks later, the patient returns to…