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.
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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.
Meet the Model Biologics Policy
At its February meeting, the ACR board of directors approved the Model Biologics Policy, which will be used when discussing guidelines and patients’ quality of treatment with health insurance companies.
HHS Enforces Stricter Rules on HIPAA
As of February 17, 2010, entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), such as group health plans and their business associates, will have to take certain actions to ensure continued compliance with the privacy and security provisions of the act.
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