ATLANTA—From step therapy requirements to infusion center locations to evaluation and management coding, insurance issues bring frequent headaches to clinicians and patients. Experts discussed some of the most recent concerns in a session at the 2019 ACR/ARP Annual Meeting. Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee (ISC), and Gary Bryant, MD, delegate to…
She wanted me to call in an antibiotic. My sister, a lawyer, often tells me how the ethics of her profession govern even her extra-professional acts. She feels that when she was sworn into the New York State bar, she lost the freedom to bend the truth. She would never, for example, attempt to smuggle…
Timothy Laing, MD, will continue to represent the ACR in his third stint on the AMA’s Relative Value System Update Committee, helping determine the relative value of clinical services.
The last day to submit Merit-Based Incentive Payment System data via the ACR RISE registry is March 16.
Using RISE? Check out the updates for 2020, including five new measures available only through the RISE registry.
Take the challenge. Scenario 1—A: The nurse practitioner may act as the supervising physician if it’s within the scope of practice for the NP and should be coded as follows: CPT: 96413, 96415, J1745 x 30, J1200 x 1 Diagnosis ICD:10: M05.79 Scenario 2—A: To qualify as an incident-to service, the PA can provide the…
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…
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…
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…
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…