The ACR/ARP’s practice management division actively works to offer rheumatologists and their staff valuable, accessible resources to address practice issues. Our trained professionals provide the most up-to-date tools and resources to help improve practice efficiency and meet the myriad compliance obligations of the ever-changing healthcare landscape.
The Practice Management Resource Center can assist with such issues as coding and billing guidelines; office compliance; documentation and denials management; and working with Medicare, private insurers and self-pay patients; as well as offering up-to-date information on clinical data registry and EHR data use to assess quality of care.
Practices can receive assistance and gain solutions to practice management, coding and billing issues via the ACR website at https://www.rheumatology.org/Practice-Quality. Key resources include:
Advanced Rheumatology Coding & CDI Boot Camp
The Advanced Rheumatology Coding and CDI Boot Camp provides physicians, coders, billers and practice managers with in-depth education on new and changing documentation requirements for clinical criteria to appropriately code the quality patient care a practice delivers. The ACR’s certified coders and CDI specialists conduct this eight-hour course and provide an overview of key coding guidelines and physician documentation requirements by body system. The course will enhance your understanding of the ICD-10 and procedural coding structure, and changes to the ICD-10-CM guidelines for frequently reported diagnoses will be discussed. Participants leave class ready to maximize documentation efforts for diagnoses and E/M and procedural codes commonly targeted for audits by third-party and government payers.
The rheumatology-specific Coding and CDI Boot Camps are offered nationwide at various locations. For a list of upcoming courses, contact the practice management division at [email protected]. Additional coding and billing resources can be found at https://www.rheumatology.org/Practice-Quality/Administrative-Support/Coding.
Evaluation & Management Chart Auditing—Avoid Audit Risks
As required by the Tax Relief and Health Care Act of 2006, the CMS implemented Medicare recovery auditing in all states. This, along with the OIG’s 2018 semiannual report on recovering more than $2 billion in overpayment, means the claims auditing movement is now moving forward at full speed. This hands-on training program is designed to assist rheumatology practices with recognizing the essential steps for documentation improvement and coding risk areas before a third-party or government audit.
For more information on self-auditing or to schedule an on-site meeting, contact the ACR’s certified healthcare auditors at [email protected]. In-depth information on CMS auditing and program integrity can be found at https://www.rheumatology.org/Practice-Quality/Administrative-Support/Practice-Resources/Audit-Programs.
Certified Rheumatology Coder Review Course & Exam
The CRHC exam is designed to provide information and thoroughly test the coding knowledge of professionals in rheumatology, including physicians, coders/billers, office managers, administrators, consultants and other health professionals. The ACR’s practice management division will send its Professional Medical Coding Curriculum (PMCC) coding instructor to conduct a daylong review course and administer the three-and-a-half hour exam at several U.S. locations. To review the certification guidelines or register for a course, visit the ACR website at https://www.rheumatology.org/Learning-Center/Educational-Activities/Details?meetingId={C818A218-D658-E611-8F1A-005056987EFD}.
Business Side of Rheumatology
A practical online business manual for rheumatologists, fellows in training and practice administrators on starting, selling or redesigning a rheumatology practice can be downloaded from https://www.rheumatology.org/Practice-Quality/Administrative-Support/Practice-Resources/Practice-Publications.
Rheumatology Coding Manual
This electronic coding reference is a practical guide for rheumatologists and their staff to communicate effectively with third-party payers regarding the medical services provided to patients. The Rheumatology Coding Manual can also be used by practices as a hands-on tool for new clinical and coding staff to familiarize themselves with rheumatology coding. Download this practical guide from https://www.rheumatology.org/Practice-Quality/Administrative-Support/Practice-Resources/Practice-Publications.
Insurance Template Letters
The ACR provides letter templates describing the ACR’s position on proper reimbursement practices for rheumatology services. These letters can be used to assist in obtaining insurance approval and coverage for off-label drug uses common in rheumatology practice. The templates can be downloaded from the ACR website at https://www.rheumatology.org/Practice-Quality/Administrative-Support/Insurance-Advocacy/Tools-Resources.
Insurance Advocacy
The ACR’s Insurance Subcommittee (ISC) to the Committee on Rheumatologic Care works with insurance companies on payment and policy issues affecting rheumatology practices. This group monitors insurance policy changes and assists with member requests for support when a payer’s decision negatively affects a member’s practice. In an effort to better address individual and systemwide insurance issues, the ACR developed a standardized complaint form, which can be completed and submitted to the ACR for assistance. If you are experiencing a problem with an insurance health plan, download and complete the complaint form at https://www.rheumatology.org/Practice-Quality/Administrative-Support/Insurance-Advocacy.
Education
The practice management division works with the Education Department to offer sessions at the ACR/ARP Annual Meeting. This year’s premeeting practice management workshop, Practice Matters: Navigate A Path to Success! on Saturday, Nov. 9, will focus on key practice matters. The goal of this workshop is to address how best to manage your practice within an ever-changing environment of managed care, compliance, third-party payers, regulators and declining reimbursements. Visit the ACR website for registration information at https://www.rheumatology.org/Annual-Meeting.
RISE Registry
The Rheumatology Informatics System for Effectiveness (RISE) registry is a unique tool created by the ACR to help rheumatologists improve patient care. RISE extracts clinical data directly from the EHR systems of participating individuals or practices, aggregates these data centrally and provides easily understandable analytics. RISE provides participants with an infrastructure for robust quality improvement activities leading to improved patient outcomes, patient population management and quality reporting related to rheumatic diseases and drug safety. RISE may be used for MIPS reporting requirements and for general quality improvement in your practice. To learn more and join the registry, visit the ACR website at https://www.rheumatology.org/I-Am-A/Rheumatologist/RISE-Registry/RISE-for-Practices.
In Sum
The ACR/ARP places a concentrated focus on the importance of continuing education in coding and practice management. Rheumatology practice administrators and managers must pay close attention to financial management, compliance issues, billing and coding changes. The ACR/ARP is in the perfect position to provide appropriate education and training for rheumatologists and their staff to run an effective and efficient practice. ACR/ARP members also receive discounted rates for all educational offerings.
For questions or additional information, or to schedule a course in your area, contact the ACR coding and practice management staff at [email protected].
