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Health Plans Enact Coverage Policies for Remicade & Infliximab Biosimilars

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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…

How to Avoid Insurance Denials for Prescribing a Biologic Without MTX in Concert

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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…

Submit MIPS Data to the CMS via RISE by March 2

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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…

Rheumatologist Shortage Looms Amid Surging Patient Demand

Lisa Rapaport  |  

(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…

Congress Urged to Fix CMS Rule Distorting Part B Drug Reimbursement

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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…

RISE Readiness for MIPS in 2018

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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…

2018 CPT Coding Updates

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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…

Medicare Access & CHIP Reauthorization Act Preparation Tips

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The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…