What do you do when you are presented with a patient who needs treatment but the patient’s insurance company will not pay for the services? Can you provide the services anyway? Who will pay for them? How do you collect payment for such services? If the patient consents to receive the services in spite of…
Although there are seven components for the levels of evaluation and management (E/M) services, most encounter levels are coded on the basis of the history, examination and medical decision making (MDM), which are the key components extracted from documentation in the medical record. However, when counseling and coordination of care for a patient are the…
On behalf of the rheumatology community, the ACR recently submitted an entry for a rheumatology-specific Clinical Practice Improvement Activity (CPIA) that, if accepted, will be included in the 2018 performance year. The CMS put a call out to the public for CPIAs in an attempt to make MACRA more meaningful for participating providers. The ACR…
ACR members are spread out across the U.S., but we all work in the same place: the land of fee for service. FFS, as it’s known to policy nerds, poses certain problems for cognitive subspecialists like rheumatologists. For instance, much of the work we do—calling providers and patients, coordinating care after hours—often isn’t compensated. And…
The ACR Insurance Subcommittee (ISC) regularly engages with insurance companies to discuss concerns raised by ACR members and advocate for appropriate coverage and payment policies. The ISC has gotten off to a busy start in 2017, working on a variety of patient access and reimbursement issues. Two recent issues the ISC has taken action on…
NEW YORK (Reuters Health)—A new position paper from the American College of Physicians (ACP) aims to reduce administrative tasks in health care. Reducing these tasks has been an important long-term objective of ACP, which developed the Patients before Paperwork initiative in 2015 as part of this effort. In a publication online on March 27 in…
WASHINGTON (Reuters)—U.S. President Donald Trump made a final push on Thursday to win over skeptical members of his own Republican Party to begin dismantling Obamacare in the House of Representatives or risk failure on one of his top legislative priorities. The effort is seen by financial markets as a crucial test of Trump’s ability to…
WASHINGTON (Reuters)—Uncertainty surrounding the Republican plan to replace Obamacare is forcing some U.S. hospitals to delay expansion plans, cut costs, or take on added risk to borrow money for capital investment projects, dealing an economic blow to these facilities and the towns they call home. Hospitals typically lay out multi-year operating plans that prioritize investments,…
(Reuters Health)—Patients may be less likely to die in U.S. hospitals during weeks when accreditation inspectors show up unannounced than during other times of the year, a recent U.S. study suggests. Researchers examined mortality data for 1,984 hospitals nationwide from 2008 to 2012. During surprise inspections, 7.03% of patients died within 30 days of being…
WASHINGTON, D.C.—In a session during the 2016 ACR/ARHP Annual Meeting, aptly called Quality Measures and Quality of Care I, a panel of experts presented information on a number of programs underway in rheumatology using quality measures to both assess and improve patient outcomes. Leading off were two presentations on programs using quality measures to improve…