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Search results for: health insurance

Case Report: A 5-Year-Old with an Ischemic Digit

Marta Michalska-Smith, MD, & Colleen K. Correll, MD, MPH  |  September 14, 2021

Janus kinase 1 and 2 inhibitors (jakinibs) have been approved for the treatment of rheumatoid arthritis, psoriatic arthritis and, most recently, juvenile idiopathic arthritis. They have also shown promise in the treatment of interferon (IFN) mediated diseases. The Janus kinase and signal transducer and activator of transcription (JAK/STAT) pathway is the principal signaling pathway for…

Filed under:Conditions Tagged with:Aicardi-Goutières SyndromeJanus Kinase Inhibitors

ACR Practice Experts Can Answer Challenging Business Questions

Carina Stanton  |  September 7, 2021

Coding questions and billing compliance are just a few of the issues ACR practice management specialists can help managers and rheumatologists navigate to recoup reimbursement and ensure timely patient treatment.

Filed under:American College of RheumatologyBilling/CodingFrom the CollegePractice Support Tagged with:ACR/ARP practice management resourcesBilling & Codingevaluation and management (E/M) codesMember benefits

FDA Requires New Boxed Warnings on JAK Inhibitors, Places Restrictions on Use

Keri Losavio  |  September 1, 2021

On Sept. 1, the U.S. Food & Drug Administration (FDA) announced that it is requiring revisions to the Boxed Warning for the Janus kinase (JAK) inhibitors Xeljanz/Xeljanz XR (tofacitinib), Olumiant (baricitinib) and Rinvoq (upadacitinib) to include information about the risks of serious heart-related events, cancer, blood clots and death.1 Recommendations for healthcare professionals will include…

Filed under:Drug Updates Tagged with:baricitinibJAK inhibitorsjakinibsTofacitinibupadacitinib

Georgia Bonney

Prior Authorization Woes: Barriers to & Delays in Care, Administrative Hassles & Potential Solutions

Larry Beresford  |  August 6, 2021

As insurers phase out pandemic-related flexibilities, many are raising new obstacles to try to limit their financial exposure.

Filed under:Legislation & AdvocacyPractice Support Tagged with:Advocacyprior authorization

3 Educators Offer Lessons Learned on Rheumatology Training

Leslie Kahl, MD, Sheryl Mascarenhas, MD, & Rachel M. Wolfe, MD  |  July 15, 2021

Leslie Kahl, MD, on Coaching I have been an academic clinician-educator for my entire career and, like most of my colleagues, have been called upon to advise, mentor and coach countless trainees and junior faculty members. Unlike most clinician-educators, though, I also served as associate dean for student affairs at Washington University School of Medicine,…

Filed under:Education & Training Tagged with:FellowsFellows-in-Trainingfellowship program director

High Cost of Specialty Drugs Demands Action

Mary Beth Nierengarten  |  July 6, 2021

Amid rising drug costs and the growing influence of pharmacy benefit managers on patient care decisions, physicians are increasingly called upon to advocate for affordable, evidence-based treatments for their patients.

Filed under:Legislation & AdvocacyPractice Support Tagged with:drug pricingpharmacy benefit managers (PBMs)

A Unified Advocacy Voice for Rheumatology

David R. Karp, MD, PhD, & Christine Stamatos, DNP, ANP-C  |  June 13, 2021

One thing that became clear very quickly this past year was that the COVID-19 pandemic would change the way we deliver care to patients. What has not changed amid an evolving healthcare landscape is our driving focus to ensure our patients’ access to rheumatology care and the availability of state-of-the-art treatments. We know you share…

Filed under:Legislation & AdvocacyPresident's Perspective Tagged with:COVID-19RheumPACSafe Step Act

Improving Seniors’ Timely Access to Care Act Reintroduced in House

From the College  |  June 7, 2021

The Improving Seniors’ Timely Access to Care Act (H.R. 3173) will require the Centers for Medicare & Medicaid Services to regulate the use of prior authorization by Medicare Advantage plans and establish a process to make real-time decisions for services that are routinely approved. Ask your Congressperson today to support providers and patients and join the more than 100 representatives who are co-sponsoring the bill.

Filed under:Legislation & Advocacy Tagged with:AdvocacyLegislationprior authorization

Medicare Contractors Provide Guidance for Use of JA, JB Modifiers

From the College  |  June 7, 2021

As of April 2021, Medicare requires the use of the JA or JB modifier when billing for drugs that have one Healthcare Common Procedure Coding System Level II (J or Q) code but multiple routes of administration.

Filed under:Billing/Coding Tagged with:BillingModifierself-administration

ACR Leads AMA Resolution on Payer Financial Incentives to Patients to Switch Treatment

From the College  |  May 22, 2021

Spurred by a recent Cigna policy, the ACR will lead a resolution to oppose insurance companies providing financial incentives for patients to switch treatments. Several specialties are cosponsoring the resolution for a special meeting of the AMA House of Delegates in June.

Filed under:InsuranceLegislation & Advocacy Tagged with:AMA House of Delegates (HOD)insurance

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