A 50-year-old male patient returns to the office for a follow-up visit for a diagnosis of generalized primary osteoarthritis of multiple sites. The patient tells the medical assistant that he is experiencing sharp throbbing pain in his left hip and right and left knees. He states the pain level is 6 out of 10 and…
The ACR Insurance Subcommittee Advocates for Fair Payer Policies
The ACR is committed to advocating for appropriate coverage and payment policies. The volunteer members of the Insurance Subcommittee (ISC) lead this effort by representing the ACR and its membership to the insurance industry. The ISC engages payers to ensure their policies are clinically appropriate and promote patient access to high-quality care and treatment. The…
RheumPAC Contributions Needed in 2017 to Educate Federal Policymakers about Rheumatology Concerns, Interests
2016 was an impactful year for ACR advocacy efforts. Last month we reviewed our advocacy accomplishments in 2016, accomplishments that benefited 100% of our members. However, more than 95% of ACR and ARHP members had not invested in RheumPAC by the conclusion of the 2016 ACR/ARHP Annual Meeting. Each year, many of the same dedicated…
Rheumatology Coding Answer: Deconstructing Evaluation and Management Codes
Take the challenge. Answers: B: No—Only the treating physician can take the HPI. The medical assistant is allowed to take the review of systems. If the documentation indicates the treating physician did not take the HPI, the insurance can deny the claim as not medically necessary. B: No—If the high-risk medication is not assessed and…
How to Win the ACR Knowledge Bowl
Did you know that the ACR holds an annual Knowledge Bowl competition in conjunction with the ACR/ARHP Annual Meeting? Two fellows, along with a faculty mentor, compete in two to three rounds of trivia, modeled on the television game show Jeopardy! For the past three years I have participated, along with my team, the University…
Charity Navigator Awards Rheumatology Research Foundation with Eighth Consecutive Four-Star Rating
Charity Navigator, America’s largest and most-used independent evaluator of charities, has awarded the Rheumatology Research Foundation with its eighth consecutive four-star rating. The prestigious ranking is the highest possible award given out by Charity Navigator and recognizes good governance, sound fiscal management and commitment to accountability and transparency. Charity Navigator President and CEO Michael Thatcher…
CMS Cancels Medicare Part B Demonstration Project
When the controversial Medicare Part B Drug Payment Model final rule was not released by the Centers for Medicare & Medicaid Services (CMS) as expected before Nov. 21, it signaled an increasing likelihood of defeat for the proposed rule—a signal proved true on Dec. 15. A spokesperson for the CMS said, “After considering comments, CMS…
Rheumatology Coding Corner Year-End Quiz Answers
Take the challenge. D—As of January 2015, there are three new codes added to the arthrocentesis codes of 20600–20611. The new codes, 20604, 20606 and 20611, should be reported when the procedure is performed with ultrasound guidance and CPT 76942 should not be billed separately. The three new codes are defined as: 20604—Arthrocentesis, aspiration and/or…
New Physician Payment Reforms Highlight Need for Quality Coding, Accurate Documentation
To be an effective practice owner, it is necessary to understand the financial circumstances and environment of the practice’s operation. Well-managed practices prevent the loss of time and money. Therefore, to improve productivity and operating efficiencies, you need to have a basic understanding of billing and payment initiatives that will impact the practice’s bottom line….
RheumPAC Advances Policy Issues of Rheumatology Professionals
Our elected officials make decisions every day that affect our lives and the lives of our patients. These decisions are often based on input they have received from advocates and lobbyists, constituents and fellow lawmakers. Regardless of our ideals, money plays a role in this decision making, because political contributions facilitate access to legislators and…
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