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.
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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.
SCHIP Legislation a Priority
There are approximately 9 million uninsured children in the United States, and the number is increasing. Of those 9 million, 6 million are eligible for – but not enrolled in – the State Children’s Health Insurance Program (SCHIP) or Medicaid.
Combine With Medicare Part D to Help Patients Afford Prescriptions
According to the 2003 U.S. Census, 29 million people in the United States make less than 200% of the federal poverty level and have no health insurance. Many persons have difficulty affording prescribed medications. In addition to Medicare Part D, there are more than 350 public and private patient assistance programs, including programs by pharmaceutical companies, that help patients pay for prescriptions.
ACR Responds to Cigna Downcoding of Evaluation & Management Codes
The ACR recently sent a letter to Cigna opposing its new policy, which would result in downcoding of level 4 and 5 evaluation and management claims.
ACR Urges Strong AI Safeguards in State Model Legislation
In comments to the National Association of Insurance Commissioners, the ACR outlined several recommendations for a proposed state model law addressing the use of artificial intelligence in the insurance industry.
ACR-Led Resolutions Supporting Research Funding, Biosimilars Access Advance at Annual AMA House of Delegates Meeting
An ACR-led resolution that calls for the protection of NIH funding and the ability to negotiate indirect costs will become AMA policy, along with several other resolutions supported by the ACR.
Aetna Expands Evaluation & Management Downcoding Program
Aetna recently expanded its Claim and Code Review Program, which results in the downcoding of certain level 4 and 5 evaluation and management claims. Practices are advised to monitor remittance documents for appropriate reimbursement.
President’s Corner: The ACR & Pediatric Rheumatology
My first exposure to pediatric rheumatology came during my adult rheumatology fellowship, when pediatric rotations were part of our curriculum. This experience brought home for me the many differences between childhood and adult rheumatic diseases and the important role pediatric rheumatologists play in patient outcomes. This role has long been appreciated by the ACR/ARP, where…
CMS Nominee Mehmet Oz’s Stated Policy Priorities & Rheumatology
With Mehmet Oz, MD, expected to be confirmed as administrator of the Centers for Medicare & Medicaid Services, the ACR considers how his stated priorities may affect rheumatology.
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