Purchasers of healthcare are beginning to take a more active role in ensuring they receive value for their health care dollars, and these savvy shoppers want to develop programs to increase the quality and efficiency of the care they purchase. This movement has given rise to the concept of value-driven healthcare, commonly called value-based purchasing. Over the next three months, “From the College” will take a look at this type of purchasing and provide rheumatologists and rheumatology health professionals with practical advice on how to stand out to these value-based purchasers.
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Healthcare in the Obama Administration
The ballots are counted, the run-off elections are complete, and a new administration and Congress are set to begin. You may recall that the mock election that was held during the 2008 Annual Scientific Meeting—78% of U.S. meeting attendees chose Barack Obama as their next president—and the general election echoed that choice. On January 20, Barack Obama was sworn in as the United States’ 44th President.
Five Answers You Won’t Get From Insurance Carriers
Have you ever called a carrier and asked why something was denied? If you work in a rheumatology practice, chances are you have, and you probably hung up feeling even more confused than before you made the call.
UnitedHealth Group to Require MRI Accreditation
Starting March 1, 2008, UnitedHealth Group will require all freestanding facilities and physician offices that perform MRIs and certain other imaging studies to obtain accreditation. Physicians without accreditation will not be reimbursed for the technical or global codes. UnitedHealth Group is the umbrella organization for insurance companies such as United Healthcare, Ovations, and AmeriChoice.
A Look Back at 2024 Regulatory Developments
In 2024, key federal healthcare regulations and policy developments—related to health insurance, privacy protections, reimbursement, biosimilar use and more—shaped the landscape of the practice of rheumatology in several important ways.
Commercial Payers Update Reimbursement for Underwater Infliximab Biosimilars
Three commercial health insurance payers have increased reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
Copay Accumulator & Maximizer Programs Threaten Access to Treatment
As health insurance companies and third-party benefit managers continue to use copay accumulators and maximizers to shift the cost of specialty drugs to patients, the ACR continues to advocate against programs that limit copay assistance.
Do Tiered Physician Networks Help or Hurt? What Rheumatologists Should Know
Health insurance plans are increasingly favoring tiered physician networks, which some fear have the potential to limit patient access to such specialties as rheumatology to achieve short-term cost reduction…
RHEUMATOLOGY PRACTICE PEARLS: Beware of Charting Pitfalls
Are your medical records up to date and complete? Medical records should always be complete and have accurate documentation to avoid violating the Health Insurance Portability and Accountability Act or other documentation guidelines.
Managing Patient Records
Physician practices handle patient records that contain sensitive information—including financial, demographic, and medical data—on a day-to-day basis. This type of information can put a practice, as well as the patient, at risk if not handled properly. Rheumatology practices should make sure that they have policies and procedures in place for keeping and distributing patient records. In fact, the federal Health Insurance Portability and Accountability Act (HIPAA) has set a national standard for the privacy of health information.
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