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Articles by From the College

Insurance Subcommittee Responds to Health Plan Complaints

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The ACR Insurance Subcommittee (ISC) regularly engages with insurance companies to discuss concerns raised by ACR members and advocate for appropriate coverage and payment policies. The ISC has gotten off to a busy start in 2017, working on a variety of patient access and reimbursement issues. Two recent issues the ISC has taken action on…

Rheumatology March Coding Corner Answer: Pediatric Rheumatology Consult

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Take the challenge. CPT: 99203 This encounter is coded as 99203, because it included: History—The history of present illness was extended. The review of systems was complete, and the past medical, family and social were documented. This makes the history comprehensive. Examination—Expanded detailed. Medical decision making—The diagnosis was a new problem with no additional workup…

Undercoding Is Not an Audit-Proof Strategy in Medical Documentation

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Overcoding is a common term used when discussing fraud and abuse in reporting procedures and services not supported by the actual work performed. Alternatively, undercoding—or failing to report the full extent of services or procedures provided—is an equally unsound practice and a compliance risk. In the world of quality reporting, undercoding can have damaging effects…

RheumPAC Committee Outlines Goals for 2017

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“You can’t win last night’s game again.” —George Karl, professional basketball player and coach Amid the angst and upheaval from our recent elections and associated uncertainty for future healthcare policies, one thing remains clear: We must increase our engagement with our elected officials to educate them on the needs of our profession and our patients….

ACR Puts Forward Principles on Patient Access to Care

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The ACR has partnered with the American Medical Association (AMA) and over a dozen stakeholder groups to create a set of 21 principles to reform prior authorization protocols. This coalition represents hospitals, medical groups, patients, pharmacists and physicians with a unified goal of creating a more patient-centered, streamlined and transparent process for prior authorization. According…

Rheumatology Research Foundation Reaches $60 Million Journey to Cure Goal

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The Rheumatology Research Foundation is pleased to announce the overwhelming success of the Journey to Cure campaign. With a goal of raising $60 million, this five-year campaign was created to directly invest in the future of rheumatology by supporting training opportunities and funding innovative research. The campaign surpassed its goal, with a grand total of…

Congress Reveals Proposed ACA Replacement

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Updated 3/9/2017 The ACR is closely monitoring the American Health Care Act proposed by Republicans in Congress and will produce an analysis. In the meantime, read the ACR’s letter to Congress on healthcare reform principles. You can also read a section-by-section summary of the Ways and Means legislation and a section-by-section summary of the Energy…

RISE Is Ready for MIPS

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Implementation of the Medicare Access and Chip Reauthorization Act of 2015 (MACRA) began Jan. 1. What does this mean for rheumatologists? It means you must pick the measures by which you will be evaluated and the pace at which you will begin reporting in the Merit-Based Incentive Payment System or participating in an Advanced Alternative…

OIG Releases 2017 Work Plan: A Summary

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Each fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) puts out its Work Plan for the upcoming fiscal year to summarize its initiatives and priorities for new and ongoing work of HSS programs. Below is a summary of the key areas the OIG will focus on in 2017: Drug…