Exclusive: ACR Convergence 2024| Focus Rheums

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

From the College

Anthem Updates Modifier 25 Policy Changes after Talks with AMA

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As reported in the Dec. 28 edition of ACR@Work, Anthem Blue Cross recently announced plans to reduce reimbursement for evaluation and management (E/M) services when billed with modifier 25. At the AMA House of Delegates in November, the ACR joined with a number of other groups to support a resolution directing the AMA to advocate…

Rheumatology Research Foundation Hosts Student, Resident Experience at ACR/ARHP Annual Meeting

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On Nov. 5, more than 100 students and residents gathered for the Rheumatology Research Foundation’s Student and Resident Experience at the ACR/ARHP Annual Meeting in San Diego. As part of the Foundation’s work to increase the number of rheumatology professionals in the U.S., the event is designed to increase excitement in the field. Attendees enjoyed…

Anthem to Reduce E/M Reimbursement When Billed with Modifier 25

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Anthem Blue Cross recently announced changes to its reimbursement policies for modifier 25. As of Jan. 1, 2018, Anthem plans in California, Connecticut, Kentucky, Maine, Nevada, New Hampshire, Ohio and Wisconsin will reduce reimbursement for evaluation and management (E/M) services by 50% when billed with modifier 25. This policy will expand to Missouri on Feb….

Rheumatology Coding Corner Answers: 2017 End-of-Year Quiz

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Take the challenge. 1. B—No. CPT 99358, prolonged evaluation and management service can be billed before or after direct patient care, first hour or 99539 —each additional 30 minutes (list separately in addition to code for prolonged service). This code cannot be used to bill a higher level E/M visit code. According to 2017 CPT:…

Rheumatology Coding Corner Questions: 2017 End-of-Year Quiz

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1. A 68-year-old new female patient has an appointment to see the rheumatologist in four days. The patient has her medical records sent over from her primary care physician, neurologist and endocrinologist for the rheumatologist to review prior to the visit. Upon receipt, the rheumatologist spends 55 minutes reviewing the records and making notes. Can…

ARHP Master Designation Award Will Debut at the 2018 ACR/ARHP Annual Meeting

Elizabeth A. Schlenk, PhD, RN, FAAN, & Afton L. Hassett, PsyD  |  

The ACR Board of Directors approved the ARHP Master Designation at its August 2017 meeting. The first two ARHP Master Designation awardees will be honored at the ACR/ARHP Annual Meeting in Chicago on Oct. 20, 2018. Recognition as a Master of the ARHP is one of the highest honors that the ARHP bestows to members….

Tips to Improve Collection Rates for Patient Copays, Deductibles

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The healthcare industry is currently in an era of higher copays and deductibles, and effective patient collections are critical to the financial health of practices. The front desk staff of a practice is the first area to help with patient satisfaction and the key to a healthy revenue cycle. This front desk staff must collect…

CMS Finalizes Changes in CY 2018 for Musculoskeletal Ultrasound

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We previously alerted you to a CMS-proposed change that would cut reimbursement for the complete diagnostic musculoskeletal ultrasound (MSUS) significantly. We are pleased to report that, in its final rule, the CMS reversed that decision, and providers will see a reasonable reimbursement for the exam. The ACR advocated on your behalf for this change through…

Virtual Groups: Another Option for Reporting MIPS Participation through RISE

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RISE now has three means of reporting through the Merit-Based Incentive Payment System (MIPS): individual, group and the recently added virtual groups. According to the CMS, virtual groups allow individual MIPS-eligible clinicians or groups consisting of not more than 10 MIPS-eligible clinicians to join together and report as if they were a single entity. The…

The ACR Lobbies Against New Part B Drug Cost Adjustment Rule

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The ACR and a number of other physician medical associations are lobbying for an immediate legislative fix to a piece of the MACRA law that factors high-cost Part B drugs into a rheumatology practice’s Medicare reimbursement rate through the Merit-Based Incentive Payment System (MIPS). This change, which goes into effect immediately, will impact practices in…