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.
UnitedHealthcare Working to Correct J Code Reimbursement Error
An error in UnitedHealthcare’s claims processing system resulted in underpayments on J code claims dated Oct. 8–Nov. 8, 2023. Practices are encouraged to review all J code payments from the final quarter of 2023.
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.
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.
A Unique Partnership Gives the ACR a Voice in Insurance Legislation Development
A recent meeting of the National Council of Insurance Legislators (NCOIL) featured discussions of many topics important to ACR members, including pharmacy benefit manager legislation, biomarker testing and transparency in the healthcare market.
ACR Leads AMA Resolution on Payer Financial Incentives to Patients to Switch Treatment
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.
Cigna Offers Patients Financial Incentive to Switch Treatments
The ACR has sent a letter to Cigna expressing opposition to the initiative, which jeopardizes patients’ health, interferes with medical decision making, undermines the doctor-patient relationship and may disproportionately affect patients of lower socioeconomic status.
Ethics Forum: The Ethical Considerations of Prior Authorization
The mother of a 15-year-old patient with juvenile idiopathic arthritis/enthesitis-related arthritis (JIA/ERA) called the office in tears. She said she was having an insurance problem. Her son had been a star track athlete when he developed severe back pain. Magnetic resonance imaging showed evidence of severe sacroiliitis. He was started on a tumor necrosis factor…
ACR Advocates Against Payer Mandates on Specialty Pharmacy Acquisition of In-Office Treatments
In partnership with rheumatology and other specialty organizations, the ACR is working against payer and employer policies that mandate specialty pharmacy acquisition of in-office treatments.
How to Navigate & Manage Insurance Overpayments
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…
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