Scenario 1: Direct Billing A 70-year-old female patient with rheumatoid arthritis in multiple joints and positive rheumatoid factor returns to the practice for her fourth infusion of infliximab with the nurse practitioner (NP). She reports no fevers, cough, dyspnea or concurrent illness. She rates the severity of her joint pain at 6 on a 10-point…
Don’t Miss 2020 E/M Coding Workshop in New Orleans
Access to good training and education on practice management and coding issues has proved beneficial to physician success. Getting up-to-date information on compliance, insurance reimbursement, office efficiency, coding and billing is crucial for effective and efficient practice management. The ACR’s Committee on Rheumatologic Care (CORC) has created the premier one-day E/M Documentation Trends and Best…
Tactics for Bolstering the Rheumatology Workforce
ATLANTA—The rheumatology profession faces a severe shortfall of practitioners that threatens the ability to address patients’ needs. “Even if we doubled the number of positions for fellowship training, we wouldn’t meet the increasing demand on our workforce,” said Marcy B. Bolster, MD, associate professor of medicine at Harvard Medical School, Boston, and director of the…
Copay Accumulator Programs Can Derail Rheumatologic Treatment Plans
As the medications for rheumatology become more expensive, the need for patient financial assistance becomes paramount. Unfortunately, commercially insured patients are finding it difficult to afford the exorbitant copays required by their plans, and the latest strategy of pharmacy benefit managers (PBMs) threatens to derail rheumatologic treatment goals. High deductible plans combined with copay accumulator…
Coverage & Reimbursement Challenges: Updates from the ACR Insurance Subcommittee Chair
The ACR Insurance Subcommittee is working to address specialty pharmacy requirements for in-office treatments, elimination of consultation codes and other coverage and reimbursement challenges.
Are Your Patients at Risk? Advocacy Matters
When insurance company practices put patients at risk, advocacy is an important tool physicians can use to make a real difference. You can make a difference.
Evaluation & Management Code Changes Set for 2021
Major changes to office and outpatient evaluation and management codes 99201–99205 and 99211–99215 will take effect Jan. 1, 2021.
Support Pediatric Subspecialty Loan Repayment to Boost Workforce Growth
Current legislation that stipulates a loan repayment program for pediatric subspecialists could help the pediatric rheumatology community attract trainees and meet patient demand.
How to Work with Sales & Marketing Representatives in Your Practice
Sales and marketing representatives can add tremendous value to your practice: They can generate consistent business by leveraging contacts who have services that can be referred to your practice. However, the services a sales and marketing representative provides are subject to significant scrutiny under the federal Anti-Kickback Statute and state equivalents. For this reason, the…
Tips for Smoothing the Time-Consuming Prior Authorization Process
ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…
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