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….
Search results for: primary care providers
Patient Sexual Orientation & Gender Identity: Do You Need to Know?—Ethics Forum
A 17-year-old girl presents to the pediatric rheumatology clinic for follow-up of recently diagnosed systemic lupus erythematosus (SLE) characterized by class IV lupus nephritis, photosensitive rash and antiphospholid antibody positivity. She is currently being treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. She is accompanied by her mother, who has been very involved in the patient’s…
A Collaborative Website as a Communication Model During the COVID-19 Pandemic
Under the onslaught of developing information on COVID-19, one health system found a way to streamline communication using a secure tool it already had access to.
Rheumatology in the Age of COVID-19: HCQ Shortages Driven by Small, Nonrandomized Study
No data exist for prescribing hydroxychloroquine for post-exposure prophylaxis, and we should not prescribe it for this indication.
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.
As Lyme Disease Spreads Across the U.S., Stay Alert for Fatal Lyme Carditis
The reach of Lyme disease is expanding across the U.S., and cases may be under-reported. A recent CDC case report describes the experiences of two patients with fatal cases of Lyme carditis…
15% E/M Services Reimbursement Hike a Win for Rheumatology
ACR advocacy leaders are celebrating a 15% planned increase in reimbursement for rheumatology evaluation and management services and are calling on members to thank Congress.
Proposed Changes May Loosen Federal Fraud & Abuse Laws
The Stark law and the Anti-Kickback Statute (AKS) are the U.S. healthcare system’s primary fraud and abuse laws, and highly anticipated proposed reform plans from the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) were finally unveiled on Oct. 17, 2019. The proposed reforms would 1) clarify certain requirements…
Sjögren’s Syndrome in Kids: Diagnostic Challenges & Treatment Options
A 14-year-old girl is referred to your office for fatigue and arthralgias. While you’re obtaining her past medical history, she divulges that she has had four episodes of bilateral parotitis, each lasting two weeks. An otolaryngologist evaluated her. She lacked sicca symptoms, had a normal complete blood count (CBC), normal inflammatory markers and a negative…
Achieving Clinical Documentation Improvement in 2020
Although the Centers for Medicare & Medicaid Services (CMS) is simplifying documentation through its Patients over Paperwork initiative, clinical documentation improvement (CDI) did not go away. CDI is not about how to code in ICD-10-CM or the Current Procedural Terminology (CPT); instead, it is a huge part of the solution in maximizing the integrity of…
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