The Insurance Subcommittee is working on behalf of ACR members to address underwater formulary requirements for biosimilars, mandated switches to biosimilars, evaluation and management downcoding and more.
Hit the Ground Running with New Insurance Subcommittee Chair Michael Feely, MD
Dr. Feely discusses his previous work with the College, his current work as a practicing rheumatologist and how he will lead continued advances on the insurance front.
Resources for Practices to Fight Payer Downcoding of E/M Services
The American Medical Association and ACR Insurance Subcommittee offer support and guidance to help practices recognize and push back against downcoded payments for evaluation and management services.
How the ACR Helps with Reimbursement, Utilization Management & Other Practice Challenges
Improving reimbursement for underwater biosimilars is just one example of how the ACR’s practice advocates have achieved solutions to members’ insurance challenges. Here’s a look at current ACR efforts in insurance advocacy and how to get help with your own insurance challenges.
Updates from the ACR Insurance Subcommittee
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices, including issues related to biosimilar use, in-office treatments and the new G2211 code.
The Biosimilar Economic Conundrum: Where We Stand
Reimbursement has fallen below acquisition price for some biosimilar versions of infliximab, forcing practices and patients to make difficult decisions. The ACR is working to change this.
Updates from the ACR Insurance Subcommittee Chair
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices. Recent activities include efforts to avoid increased administrative burden associated with specialty medications, support payer coverage of musculoskeletal ultrasounds and protect patient access to biologics.
The ACR Opposes New AI-Based Decision-Making Platform
On July 1, Blue Cross Blue Shield of North Carolina introduced a machine-learning technology platform to make decisions about patients’ care and treatment. The ACR opposes its use on grounds that it may harm patients’ access to treatment and undermine the doctor-patient relationship.
ACR Insurance Subcommittee Tackles Known Issues
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.