Charity Navigator, America’s largest and most-utilized independent evaluator of charities, has awarded the Rheumatology Research Foundation its ninth consecutive 4-star rating. The prestigious 4-star rating is the highest possible rating given and is based on good governance, sound fiscal management and commitment to accountability and transparency. “The Rheumatology Research Foundation is proud to receive this…
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
Prior authorization treatment delays, the preferred status conferred on some drugs by pharmacy benefit managers and exorbitant co-payments were among the issues brought before the U.S. Senate Special Committee on Aging on Wednesday, Feb. 7. William F. Harvey, MD, MSc, FACR, a practicing rheumatologist at Tufts Medical Center in Boston and volunteer on the ACR…
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…
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…
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…
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…
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…
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…
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…