H.R. 807, Medicare Access to Rehabilitation Services Act of 2017, will be one of the key issues discussed when members of the ACR’s Government Affairs Committee (GAC) visit Capitol Hill Sept. 26 during the annual Advocates for Arthritis event. This bill—as well as its companion bill in the Senate, S. 253—is aimed at repealing the…
Search results for: Medicare Part B
ACR Supports Bill for Increased Medicare Contractor Transparency
Working with more than 40 other medical associations, the ACR is supporting proposed federal legislation, the Local Coverage Determination Clarification Act of 2017 (S. 794). The bill is co-sponsored by Sens. Johnny Isakson (R-Ga.), Tom Carper (D-Del.), John Boozman (R-Ark.) and Debbie Stabenow (D-Mich.). The bill’s provisions would add transparency to how Medicare Administrative Contractors…
The Important Role of the AMA RVS Update Committee in Medicare Payments
Believe it or not, change begins with one person willing to lead by example—and you can be that person. All too often, we get caught up with the changes we want. However, instead of talking about what we would like, it’s time to lead. The best way to do this is to show others you’re…
U.S. Accuses UnitedHealth of Medicare Advantage Fraud
(Reuters)—The U.S. Justice Department (DOJ) has accused UnitedHealth Group Inc. of obtaining inflated payments from the government based on inaccurate information about the health status of patients enrolled in its largest Medicare Advantage Plan.1 The complaint, filed in federal court in Los Angeles on Monday, came after the DOJ earlier this year intervened in two…
How to Bill Medicare Patients for Non-Covered Services
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…
S.C. Rheumatism Society Benefits from ACR Partnership
Editor’s note: This article will be the first in a series of articles highlighting the advocacy work done by state and local societies around the country. The South Carolina Rheumatism Society (SCRS) realizes multiple benefits from its association with the ACR, according to Jeffrey G. Lawson, MD, the society’s treasurer. One example of the support offered:…
UnitedHealth Sued by U.S. Over Medicare Charges
(Reuters) – The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit against UnitedHealth Group Inc. that claims the country’s largest health insurer and its units and affiliates overcharged Medicare hundreds of millions of dollars, a law firm representing the whistleblower said on Thursday. “We reject these more than five-year-old claims and will contest…
Reminder: How to Handle Part D Prior Authorization Requests
As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B, but when it’s used as an oral agent for rheumatoid arthritis, it’s covered by Part D. Early in the…
FDA Releases Biosimilar Guidance, Medicare Will Cover Infliximab-dyyb & More
The FDA has released guidance for the development of biosimilars, and Medicare will cover Inflectra (infliximab-dyyb) in 2017…
Pfizer Announces Medicare Reimbursement for Inflectra (infliximab-dyyb), the First Biosimilar Monoclonal Antibody Available in the United States
On Jan. 6, Pfizer Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has included payment information for INFLECTRA (infliximab-dyyb), a biosimilar to REMICADE (infliximab), in its January Average Selling Price (ASP) pricing file. This pricing took effect as of January 1, 2017. Additional claims processing information is listed in the MLN Matters…
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