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Articles by From the College

Reimbursement Options for Services Without Direct Patient Contact

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Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…

Coding Corner Answers: Navigating Medicare’s Online Resources

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Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…

Coding Corner Questions: Navigating Medicare’s Online Resources

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A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…

How to Navigate & Manage Insurance Overpayments

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Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…

Leading Boldly: Transforming Rheumatology Campaign Makes Progress

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In 2018, the Rheumatology Research Foundation embarked on its third and most ambitious fundraising campaign, Leading Boldly: Transforming Rheumatology, with a goal of raising $75 million over five years. The campaign supports Foundation programs to recruit the best and brightest into the field, train rheumatology professionals at all career stages and support investigators conducting research…

Coding Corner Answer: An Insurance Billing Quiz

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Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…

Coding Corner Question: An Insurance Billing Quiz

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A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…

Pediatric Rheumatology Learning at the 2019 ACR/ARP Annual Meeting

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At this year’s ACR/ARP Annual Meeting, Nov. 8–13, all of the pediatric rheumatology sessions will take place in the same room, making it easy to access all of the exciting content. Planners hope this convenient setup facilitates networking before and after symposia. “In pediatric rheumatology, we are very tight-knit community. This [event] is our opportunity…