Example 1 A cardiologist contacts a rheumatologist concerning a lupus patient. The rheumatologist sees the patient four weeks later for a complete examination. A 20-minute call is initiated to review the findings and the patient’s chart with the cardiologist. After the call is completed, the rheumatologist completes a verbal and written report to the patient’s…
In case you missed it, on Nov. 20, the Centers for Medicare & Medicaid Services (CMS), a department within the U.S. Department of Health and Human Services, announced that it will overhaul the payment system for Medicare Part B (i.e., infusion) drugs on Jan. 1, 2021. The plan is called the Most Favored Nation (MFN)…
Humans may fear change as a general rule, but we’re adaptable when we need to be. In this era of COVID-19 and social distancing, medical practices and payers are adapting to an increased use of telemedicine, which enables providers to see their patients without being in a room with them. To cope, the Centers for…
ATLANTA—From step therapy requirements to infusion center locations to evaluation and management coding, insurance issues bring frequent headaches to clinicians and patients. Experts discussed some of the most recent concerns in a session at the 2019 ACR/ARP Annual Meeting. Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee (ISC), and Gary Bryant, MD, delegate to…
ACR representatives updated members on recent insurance issues…
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.
ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…
Although the Centers for Medicare & Medicaid Services (CMS) is simplifying documentation through its Patients over Paperwork initiative, clinical documentation improvement (CDI) did not go away. CDI is not about how to code in ICD-10-CM or the Current Procedural Terminology (CPT); instead, it is a huge part of the solution in maximizing the integrity of…
Take the challenge. Answer: No, if billed as incident-to for the NP. Note: The patient’s current insurance carrier is Blue Cross Blue Shield of Massachusetts (BCBS of MA). Under BCBS of MA, nurse practitioners and nurse practitioner primary care providers are not allowed to perform or interpret radiology services. Therefore, the physician would have to…
Take the challenge. Answer: This is a two-part office visit scenario. The first part of the scenario illustrates the original new patient office visit, and the second portion is for the follow-up, interprofessional telephone consultation with the patient’s ophthalmologist. For the office visit … CPT: 99203 ICD-10: B30.8, M45.5, I73.00 The history was detailed, because…