Changes announced at the beginning of October have now been delayed for Actemra, Benlysta, Cimzia, Orencia and Simponi Aria, but changes to the Stelara policy remain in effect.
ACR’s Delegation to the AMA: How We Can Continue to Advance Rheumatology
The House of Delegates (HOD) is the policy-making body of the American Medical Association (AMA), and twice a year, representatives of all seated specialties, service societies and state medical associations review hundreds of resolutions to determine which will become AMA policies. Once those policies and priorities are determined or updated, we benefit from the AMA…
ACR Introduces Prior Authorization & Step Therapy Resolutions at AMA Meeting
This year, the American Medical Association (AMA) convened its annual House of Delegates (HOD) meeting June 8–12 in Chicago to discuss emerging and public health issues. Among the many policies and practices discussed: two resolutions put forth by the ACR on behalf of ACR and ARP members, one concerning prior authorization and another concerning step…
What Pharmacists Want Rheumatologists to Know
Involving pharmacists in the management of chronic diseases benefits patients, says Wendy Ramey, BSPharm, RPh, CSP, a clinical pharmacy specialist in rheumatology at the University of Kentucky, Lexington. She knows this personally. As someone with rheumatoid arthritis (RA), Ms. Ramey knows pharmacists can play an important role in patient education and encouraging adherence to medications….
Gearing Up for State Legislation in 2019: 5 Issues that Need Your Attention
With a number of new legislators and new governors sworn in this month, 2019 promises to be an exciting year for state-level rheumatology advocacy. “Now is the time to reach out and share our top issues with new legislators in your state,” suggests Joseph Cantrell, ACR senior manager of state affairs. 2019 Priorities ACR Affiliate…
Common Issues That Lead to Claim Denials
In an already complicated reimbursement landscape, claims denials can potentially pose a serious issue to the financial revenue for rheumatology practices. Denials are not only highly prevalent in the healthcare environment, but also costly to appeal, which affects overall reimbursements. According to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting…
UnitedHealthcare Retires Fax Numbers Used for Prior Authorization Requests
Unfortunately, prior authorization continues to be a burden for providers, practices, and patients. Effective Jan. 1, 2019, UnitedHealthcare (UHC) will retire fax numbers used for medical prior authorization (PA) requests. After this date, UHC will require PA requests to be submitted through their Prior Authorization and Notification tool. Providers who can’t submit requests electronically may…
Prior Authorizations Hurt Patients & Practices
The ACR was part of a 16-member collaboration that created a set of 21 principles on prior authorization and utilization management, intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other healthcare organizations support those principles. Now, the AMA has released the results…
Rheumatology Coding Corner Answer: Follow-Up Knee Injection
Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale CPT Codes: 20610-LT, J7325x16 ICD-10 Code: M17.12 This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In…
Rheumatology Coding Corner Question: Follow-Up Knee Injection
On Nov. 4, a 55-year-old female patient presents to the office for a follow-up visit for injection of the left knee for osteoarthritis. This is her third of three injections that were preauthorized through Oct. 31. She reports pain and swelling in her left knee and rates the pain at an 8 on a 10-point…