During the 2017 MIPS transition year, eligible clinicians faced many challenges, including extreme and uncontrollable disasters, such as the California wildfires and Hurricanes Harvey, Irma and Maria. In light of this and the understanding that practices may not be able to collect or submit program data for an extended period of time, the Centers for…
Anthem Updates Modifier 25 Policy Changes after Talks with AMA
As reported in the Dec. 28 edition of ACR@Work, Anthem Blue Cross recently announced plans to reduce reimbursement for evaluation and management (E/M) services when billed with modifier 25. At the AMA House of Delegates in November, the ACR joined with a number of other groups to support a resolution directing the AMA to advocate…
Update on ACR’s Rheumatology-Specific APM
Efforts by the ACR to develop a rheumatology-specific alternative payment model (APM) are well under way. The first draft proposal was approved by the ACR Board of Directors in November and presented to the rheumatology community during the 2017 ACR/ARHP Annual Meeting in San Diego. The ACR is pursuing the development of a rheumatology-specific APM…
Trump Administration Rule Would Let More People Drop Obamacare
WASHINGTON (Reuters)—The Trump administration proposed a rule on Thursday to allow Americans who are self-employed or work for small businesses to buy health insurance that does not comply with all Obamacare requirements in an effort to unwind the 2010 healthcare law. The rule, put forward by the Department of Labor, would allow individuals and small…
Developing & Leading a Research Team
Translational research is designed to investigate a particular disease process to achieve an improved outcome for patients. Here are some insights into how to bring together the right people for a research team and keep that team focused…
Predatory Publishing: Know the Difference Between a Financial Scheme and Scholarly Dissemination
It happens every day. A new email pops up in a researcher’s in-box from a journal with a seemingly familiar name and an invitation to publish a research paper, present at a meeting or, perhaps, serve on an editorial board. Like many of her colleagues, Marian Hannan, DSc, MPH, professor of medicine at Harvard Medical…
Anthem to Reduce E/M Reimbursement When Billed with Modifier 25
Anthem Blue Cross recently announced changes to its reimbursement policies for modifier 25. As of Jan. 1, 2018, Anthem plans in California, Connecticut, Kentucky, Maine, Nevada, New Hampshire, Ohio and Wisconsin will reduce reimbursement for evaluation and management (E/M) services by 50% when billed with modifier 25. This policy will expand to Missouri on Feb….
Rheumatology Coding Corner Answers: 2017 End-of-Year Quiz
Take the challenge. 1. B—No. CPT 99358, prolonged evaluation and management service can be billed before or after direct patient care, first hour or 99539 —each additional 30 minutes (list separately in addition to code for prolonged service). This code cannot be used to bill a higher level E/M visit code. According to 2017 CPT:…
Rheumatology Coding Corner Questions: 2017 End-of-Year Quiz
1. A 68-year-old new female patient has an appointment to see the rheumatologist in four days. The patient has her medical records sent over from her primary care physician, neurologist and endocrinologist for the rheumatologist to review prior to the visit. Upon receipt, the rheumatologist spends 55 minutes reviewing the records and making notes. Can…
Time & Money: Tech Investments for Rheumatology
Electronic health records, personal trackers, pedometers—all these technologies result in data, data and more data. What types of technology investments will help rheumatology practices collect and understand these data? Here are some insights into investing in technology for your practice…
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