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Articles by From the College

Coding Corner Answers: An Office Personnel Quiz

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Take the challenge. D. When an infusion is ordered by the provider, there should be a signed order from the provider. If a prior authorization is needed, it should be obtained, with the number of infusions, along with the start and end dates of the authorization. Also, a prior authorization does not guarantee reimbursement; an…

Coding Corner Questions: An Office Personnel Quiz

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A 65-year-old male patient diagnosed with rheumatoid arthritis at multiple sites without rheumatoid factor has been ordered to have infliximab infusions. What should support staff do to ensure this procedure can be given to the patient? Make sure there is a signed order from the provider Make sure a prior authorization is obtained Make sure…

Analysis of National & Local Coverage Determinations

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The Medicare statute states that items and services provided to beneficiaries must be “reasonable and necessary” to qualify for reimbursement. Although the Medicare program determines in specific cases whether an item or service is reasonable and necessary, it also issues policies, called coverage determinations, to instruct Medicare Administrative Contractors (MACs) what to reimburse providers for….

ACR Expands Access to Education through Education Partner Program & New Spotlight Slide Decks

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In conjunction with the 2019 ACR/ARP Annual Meeting, the ACR piloted two new programs to provide learners with deeper, more diverse educational experiences outside of attending medical conferences. Education Partners The ACR Education Partner Program allows rheumatology professionals to consume research from the 2019 ACR/ARP Annual Meeting via multimedia video and audio platforms. A call…

CSE Award Provides Financial Support & Creates Practice Community for Recipients

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Investing in rheumatology training is essential to building a strong and capable workforce. Clinician educators are responsible for developing educational programs, instructing rheumatologists to meet accreditation standards and promoting an atmosphere of quality care for patients. Although clinician educators play a critical role in attracting the next generation of rheumatology professionals, faculty pursuing careers as…

UnitedHealthcare to Implement Fail-First Requirement for Self-Administered Orencia

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On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product. The ACR has been in communication with UHC about this policy since October 2019, when the payer…

CMS Releases Additional Updates to MIPS 2019 Submission

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The Centers for Medicaid & Medicare Services (CMS) announced last week an extension of the 2019 Merit-Based Incentive Payment System (MIPS) reporting deadline to 8 p.m. EDT on Thursday, April 30. The extreme and uncontrollable circumstances policy has also been updated to automatically apply to any MIPS-eligible providers who do not submit data by the…

Stimulus Relief Aid for Rheumatology Practices: Details & How to Apply Now

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Rheumatology practices are being hit hard by the COVID-19 pandemic. The sustainability of practices is being threatened and patient access to care is being reduced. The $2 trillion Coronavirus Aid, Relief and Economic Security (CARES) Act has numerous provisions that bring much-needed support to physicians and their practices. This includes $100 billion for healthcare providers, including physician…