The 2025 Medicare Physician Fee Schedule final rule, released Nov. 1, includes a conversion factor of $32.3465, a 2.83% drop from 2024. In response to advocacy efforts from the ACR and other medical societies, Congress recently introduced the Medicare Patient Access and Practice Stabilization Act of 2024, which would eliminate the 2.83% payment cut and provide an inflationary update for 2025 equal to 50% of the Medicare Economic Index.
CMS Updates the Medicare Conversion Factor
The Consolidated Appropriations Act, 2024 increased the Medicare conversion factor by 1.68% effective March 9, bringing it to $33.2875 for March 9–Dec. 31, 2024.
2024 Remote Physiologic Monitoring and Therapeutic Monitoring Coding Guidance
This guidance from the ACR provides information about new remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) treatment management codes
UnitedHealthcare Working to Correct J Code Reimbursement Error
An error in UnitedHealthcare’s claims processing system resulted in underpayments on J code claims dated Oct. 8–Nov. 8, 2023. Practices are encouraged to review all J code payments from the final quarter of 2023.
We Want You: Your Role in the CPT Valuation Process
Accurate reimbursement for rheumatology services ensures rheumatologists can run successful practices and provide needed care, but only if they speak up through survey input to explain how much that care costs. Here’s how to participate in the process when rheumatology CPT codes come up for review.
Updates from the ACR Insurance Subcommittee Chair
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices. Recent activities include efforts to avoid increased administrative burden associated with specialty medications, support payer coverage of musculoskeletal ultrasounds and protect patient access to biologics.
Ethics Forum: Thoughts on Managing Electronic Communication with Patients
Recent proposals in the U.S. to bill for electronic communication with our patients could be seen as a refreshing but contested attempt to battle burnout rates in the present era. A fee for electronic communications between patients and clinicians also acknowledges the value of the clinician’s time and expertise. But is this ethical? Discussion Burnout…
The ACR Opposes New AI-Based Decision-Making Platform
On July 1, Blue Cross Blue Shield of North Carolina introduced a machine-learning technology platform to make decisions about patients’ care and treatment. The ACR opposes its use on grounds that it may harm patients’ access to treatment and undermine the doctor-patient relationship.
Copay Accumulator & Maximizer Programs Threaten Access to Treatment
As health insurance companies and third-party benefit managers continue to use copay accumulators and maximizers to shift the cost of specialty drugs to patients, the ACR continues to advocate against programs that limit copay assistance.