ACR representatives updated members on recent insurance issues…
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Coverage & Reimbursement Challenges: Updates from the ACR Insurance Subcommittee Chair
The ACR Insurance Subcommittee is working to address specialty pharmacy requirements for in-office treatments, elimination of consultation codes and other coverage and reimbursement challenges.
Even with Insurance, Fewer Americans Seeing Primary Care Providers
(Reuters Health)—Almost half of U.S. adults with private health insurance are not visiting primary care providers for routine care or sick visits, a new study suggests. Between 2008 and 2016, the number of annual primary care visits for every 100 people with private health insurance declined by 22%, from 169.5 to 134.3, the study found….
ACR Insurance Subcommittee Focuses on Coverage & Reimbursement
On behalf of the ACR, I wish you happiness, prosperity and, above all, good health in this new decade. Now that the holidays are behind us and 2020 has launched, the ACR’s dedicated volunteers and staff are working collaboratively to achieve many ambitious initiatives to ensure the College’s dynamic and bright future. A few weeks…
How to Navigate & Manage Insurance Overpayments
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…
Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…
Coding Corner Question: An Insurance Billing Quiz
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…
New Wins, Ongoing Challenges for ACR Insurance Subcommittee
Corrections to reimbursement system errors with Aetna and a Medicare contractor demonstrate the latest wins for all providers by the ACR’s Insurance Subcommittee. But the committee remains hard at work advocating for rheumatologists on several fronts.
Bringing a Frontline Perspective to Insurance Advocacy
Early in his career as a resident at Washington University in St. Louis, Mo., Christopher Phillips, MD, felt a connection to his patients battling rheumatic diseases. Today, Dr. Phillips balances time with his solo private practice in Paducah, Ky., to help rheumatologists fight insurance battles for their patients in his role as chair of the…
New York City Launches $100 Million Universal Health Insurance Program
NEW YORK (Reuters)—New York City has launched a $100 million health insurance program to cover 600,000 uninsured residents, including those unable to afford coverage and those living in the United States illegally, Mayor Bill de Blasio said on Tuesday. De Blasio, now in his second term as mayor of the country’s most populous city, has…