We continue, every few months, to see payers trying to require home infusions of treatments including infliximab and rituximab. Contact us if you encounter these policies, because we strongly believe such policies are not in our patients’ best interests.
Consultation Codes
Finally, a note about consultation codes and valuation of cognitive care in general. UHC and Cigna stopped paying consultation codes last fall, both generally invoking a desire to “follow Medicare’s lead.” At the same time, we are thankful to see Medicare beginning to recognize the undervaluing of cognitive care, as evidenced by the evaluation and management fee schedule update planned for Jan. 1, 2021, which is estimated to provide a 15% increase in rheumatologists’ Medicare reimbursement. We have and will continue to press commercial payers to adjust their fee schedules to follow Medicare’s lead on this issue, citing their expressed intent to do so on previous occasions. We encourage our members to evaluate their own commercial contracts closely in light of these changes by the CMS so you can have informed conversations with your payers if or when your contracts are due for renegotiation.
Remember, the ISC exists to help members with issues related to insurance policies and payers. If you would like the ACR’s help regarding payer issues specific to your own practice or you see payer policies you think we should be aware of, reach out to [email protected].
Chris Phillips, MD, is the chair of the ACR Insurance Subcommittee of the Committee on Rheumatologic Care. He is a rheumatologist in a private practice in Paducah, Ky.
Reference
- McCormick N, Wallace ZS, Sacks CA, et al. Decomposition analysis of spending and price trends for biologic antirheumatic drugs in Medicare and Medicaid. Arthritis Rheumatol. 2020 Feb;72(2):234-241.
