NEW YORK (Reuters)—Medicare, the government-run health insurance program for elderly and disabled Americans, paid physicians $90 billion in 2013, up 17% from $77 billion in 2012, U.S. healthcare officials reported on Monday. Physician payments accounted for less than one-fifth of Medicare’s 2013 net outlays of $492 billion, which rose from $466 billion in 2012. Payments to…
High Cost of DMARDs Could Limit Medicare Patients’ Treatment Adherence
The high out-of-pocket costs of biologic disease modifying antirheumatic drugs (DMARDs) place “enormous financial strain” on Medicare beneficiaries and may limit therapy adherence, according to the lead author of a national investigation into Part D coverage and cost-sharing structures. Recently published online in Arthritis & Rheumatology, the study analyzed 2,737 Part D plan formularies for…
Rising Costs of Biologics in the U.S. Suggest Need for Negotiation Ability
The costs of some disease-modifying therapies outpace prescription drug inflation, saddling insured patients with thousands of dollars in out-of-pocket payments and delayed or denied coverage, two new studies have shown. Disease-modifying therapies for multiple sclerosis are rising in cost five to seven times faster than inflation and cost more in the United States than in…
Medicare Incident-to Billing Rules, Pitfalls
In today’s busy rheumatology practices, the services of nurse practitioners, physician assistants, occupational therapists and clinical nurse specialists are a great asset for patient flow, as well as increased revenue. As the growth of nonphysician providers (NPPs) in rheumatology practices has evolved, it has become increasingly important to understand the incident-to rules and avoid the…
The ACR Advocates for Drug Coverage, Payment Policies to Protect Rheumatology Patients, Practices
Rheumatologists must be adequately compensated for managing patients with complex drug therapies and Medicare beneficiaries need access to biologic treatments
New HCPCS Modifiers Replace -59 on January 1, 2015
Referred to as -X modifiers, they are designed to define specific subsets of -59 modifier
Congress Can Begin Work to Advance Rheumatology Before New Year
Medicare Advantage plans, specialty tier drug spending, SGR repeal, biomedical research funding issues on lawmakers’ plates
Meaningful Use Attestation Does Not Satisfy Physician Quality Reporting System Requirements
Separate clinical quality reporting measures must be submitted for each program
HIPAA Privacy Rules Bring New Enforcement Guidelines
Focus shifts from voluntary to punitive; makes business associates more accountable for breaches of personal health information
The ACR’s Benchmark Tool Helps Rheumatologists Gauge Performance
Survey lets physicians compare questionnaire responses with regional, national averages
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