The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
Submit MIPS Data to the CMS via RISE by March 2
If you have not done so already, you may submit your 2017 MIPS data to the Centers for Medicare and Medicaid Services (CMS) starting today. Log in to your RISE dashboard, click on all the MIPS categories you would like to report through RISE, and then click on the Submit button. The deadline to submit…
RISE Readiness for MIPS in 2018
In 2018, all providers will have to submit an entire year’s worth of their quality measure data to the CMS. After 2017, the transition year, the requirements and performance thresholds begin to increase. The CMS is still heavily incentivizing participation in a Qualified Clinical Data Registry (QCDR), such as the RISE registry, for reporting in…
2018 CPT Coding Updates
Each year the American Medical Association’s CPT code manual is revised to delete codes and/or guidelines, and to add or revise codes to reflect current technologies, techniques and services. Medicare and all other payers are switching to the new 2018 CPT codes for X-rays of the chest. The original codes for a chest X-ray were…
Rheumatology Coding Corner Answer: Querying Documentation for Correct Billing
Take the challenge. No, this claim is lacking proper documentation to be billed out correctly and requires querying the provider before submitting to the payer. First, a query is a written or verbal question concerning the documentation of what is being billed out and should be visible in the patient’s chart. If a query is…
Rheumatology Coding Corner Question: Querying Documentation for Correct Billing
An established, 66-year-old male patient with rheumatoid arthritis who was last seen in the office three weeks before returns to the office for an infliximab infusion. The patient reports mild pain in his right knee, right and left elbows. He rates the pain severity at a 3 on a 10-point scale. He denies any weight…
Electronic Health Record Documentation Guidelines
The operations management team in healthcare practices is expected to have an effective coding compliance program in place that is continually evaluated and reevaluated. To accurately assess the program’s effectiveness, several outcome indicators must be measured, including error rates in the provider’s documentation and the electronic health record (EHR). Due to increased scrutiny by the…
Year in Review: The ACR/ARHP/RheumPAC’s Advocacy Efforts in 2017
In 2017, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicare & Medicaid Services (CMS) reducing reimbursement through its proposed Part B Demonstration Project? If your answer to any of those questions is yes, then you directly benefited from the ACR/ARHP’s advocacy efforts….
Rheumatology Research Foundation Honors Award Recipients
SAN DIEGO—In November, the Rheumatology Research Foundation honored 155 award and scholarship recipients at the Awards Celebration, an annual luncheon, held in conjunction with the ACR/ARHP Annual Meeting. The event celebrates the accomplishments of rheumatology professionals who have received funding from the Foundation. In congratulating the award recipients, executive director Mary Wheatley, CAE, IOM, emphasized…
CMS Approves Policy to Exempt Providers Affected by Natural Disasters from MIPS 2017 Reporting
During the 2017 MIPS transition year, eligible clinicians faced many challenges, including extreme and uncontrollable disasters, such as the California wildfires and Hurricanes Harvey, Irma and Maria. In light of this and the understanding that practices may not be able to collect or submit program data for an extended period of time, the Centers for…
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