Based on a request by the ACR Insurance Subcommittee, off-label use of mycophenolate for scleroderma has been added to a Medicare-approved compendium.
How to Navigate & Manage Insurance Overpayments
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…
Tap the ACR/ARP’s Practice Management Resources
The ACR/ARP’s practice management division actively works to offer rheumatologists and their staff valuable, accessible resources to address practice issues. Our trained professionals provide the most up-to-date tools and resources to help improve practice efficiency and meet the myriad compliance obligations of the ever-changing healthcare landscape. The Practice Management Resource Center can assist with such…
Bringing a Frontline Perspective to Insurance Advocacy
Early in his career as a resident at Washington University in St. Louis, Mo., Christopher Phillips, MD, felt a connection to his patients battling rheumatic diseases. Today, Dr. Phillips balances time with his solo private practice in Paducah, Ky., to help rheumatologists fight insurance battles for their patients in his role as chair of the…
Coverage Requirements for HLA-B27 Vary by Testing Methodology
Did you know a laboratory can perform one of two different tests when a provider orders an HLA-B27 blood test? The ACR Insurance Subcommittee has received several complaints regarding commercial payer coverage for these tests, depending on which methodology the lab employs. To avoid administrative burden, members should familiarize themselves with lab practices and payer…
Protect Your Practice: Action Update From the ACR’s Insurance Subcommittee
Both private and academic rheumatology practices face payer challenges that put the health of their patients and their practices at risk. To make sure the rheumatologist perspective is heard by payers, “the ACR’s Insurance Subcommittee (ISC) serves as the interface between payers and our members and ACR colleagues,” explains Sean Fahey, MD, a rheumatologist in…
ACR Insurance Subcommittee Responds to Payer Policies
Since the beginning of the year, the ISC has sent eight letters to payers in response to problematic policies. Each letter outlines the ACR’s concerns and requests corrective action…
Should Patients with Rheumatic Disease Switch from Biologic to Biosimilar?
SAN DIEGO—Should patients with rheumatic diseases switch from a biologic to its biosimilar? At the 2017 ACR/ARHP Annual Meeting’s Great Debate, held Nov. 5, two rheumatologists argued whether to switch or stay put based on safety, efficacy and potential cost savings. First to the podium to make the case for switching, Jonathan Kay, MD, tweaked…
Unwise Choices: EHRs, PBMs, Drug Costs Are Leading to Physician Burnout
My dear electronic health records How do I dislike thee? Let me count the ways Adaptation of Sonnet 43 By Elizabeth Barrett Browning, 1806–1861 As my tenure as physician editor winds down, it’s worth reviewing some of the more nettlesome issues confronting clinicians that have been previously discussed in these pages and gauge their current…
Payer Advocacy: The CORC/ISC Is Working for Your Practice
One of the least recognized, most important (certainly for rheumatologists in the U.S. running their own practice), and hardest working committees at the ACR is the Insurance Subcommittee (ISC). Currently chaired by Sean Fahey, MD, and managed by ACR staff liaison Meredith Strozier, this group of dedicated volunteers monitors the insurance landscape, fields complaints from…