The Medicare statute states that items and services provided to beneficiaries must be “reasonable and necessary” to qualify for reimbursement. Although the Medicare program determines in specific cases whether an item or service is reasonable and necessary, it also issues policies, called coverage determinations, to instruct Medicare Administrative Contractors (MACs) what to reimburse providers for….
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CSE Award Provides Financial Support & Creates Practice Community for Recipients
Investing in rheumatology training is essential to building a strong and capable workforce. Clinician educators are responsible for developing educational programs, instructing rheumatologists to meet accreditation standards and promoting an atmosphere of quality care for patients. Although clinician educators play a critical role in attracting the next generation of rheumatology professionals, faculty pursuing careers as…
Do You Know Your Legal Obligations to Disabled Patients?
The Americans with Disabilities Act (ADA) was passed in 1990 to protect the civil rights of people with disabilities. This law, and amendments passed in 2008, resulted in rules and regulations opening access to private settings serving the public, including doctors’ offices and medical facilities. The ADA includes a three-pronged definition of disability. If any…
How to Leverage Patient-Reported Outcomes to Improve Care for SLE Patients
A recent study reinforces the growing understanding that the fatigue many SLE patients experience should be considered a lupus symptom. Researchers found that using patient-reported outcomes to identify type 2 symptoms of SLE may improve patient communication, understanding and overall care…
UnitedHealthcare to Implement Fail-First Requirement for Self-Administered Orencia
On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product. The ACR has been in communication with UHC about this policy since October 2019, when the payer…
Inflammation & Psych Issues: A Look at Potential Co-Morbidity
Rheumatic disease affects not just the body, but can also compound psychiatric disturbances, including depression, anxiety, fatigue and more, possibly making the underlying disease worse…
HHS Relaxes HIPAA Enforcement
Effective immediately, the HHS Office for Civil Rights (OCR) has stated it will not impose any noncompliance penalties under the Health Insurance Portability and Accountability Act (HIPAA) on physicians using any non-public facing service or audio or video communication technology (e.g., Apple FaceTime, Skype, Facebook Messenger, etc.) for telehealth services. This discretion applies to telehealth…
The Doctor Will See You Now: Legal & Regulatory Reforms Expand Telemedicine
In this time of COVID-19, you may be considering ways to deliver routine rheumatologic care via some form of telemedicine. Here are some of the legal considerations.
FDA Update: New Drug Approvals, New & Expanded Indications, & More
ATLANTA—New drug approvals, new and expanded drug indications, and important safety and other updates relevant for rheumatologists were presented by three physicians from the U.S. Food & Drug Administration (FDA) on Nov. 11 at the 2019 ACR/ARP Annual Meeting. New JAK Inhibitor Approved for RA On Aug. 16, 2019, the FDA approved upadacitinib (Rinvoq), an…
Physicians Identify Professional Dissonance as a Cause of Burnout
Recent research into burnout in primary care providers has found many providers experience professional dissonance and cite increasing paperwork and undervaluation as contributors to burnout. The study also outlined solutions that may improve professional fulfillment…
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