In the next few weeks, you may be selected to participate in an AMA/Specialty Society RVS Update Committee (RUC) survey for physician office visits (99202-99205, 99211-99215) and a new prolonged services code (99XXX). As you may know, the components of the Medicare Physician Payment Schedule are physician work, practice expense and professional liability insurance. This…
Early Activity Holds Signs of Hope for 2019 State Legislative Cycle
The 2019–2020 legislative cycle in the states holds real hope and opportunity for critical reforms to protect rheumatology practices and patients. It is important to note that because of the state legislative process, bill passage almost always comes later in the legislative session. Although the rheumatology community has not yet seen many official wins, early…
Training Is the Path for Documentation & Coding Improvement
Join us for the Rheumatology Documentation and Coding Workshop taking place during the 2019 State-of-the-Art Clinical Symposium, Friday, April 5 in Chicago. The Rheumatology Documentation and Coding Workshop will take a deep dive into the new Medicare coding and documentation requirements for evaluation and management coding, medical decision making and specificity in diagnosis coding. Due…
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…
CMS Says U.S. Health Spending to Rise 5.5% Per Year over Next Decade
(Reuters)—U.S. health spending is expected to grow at an average rate of 5.5% every year from 2018 over the next decade and will reach nearly $6 trillion by 2027 as more people become eligible for Medicare, a government health agency said on Wednesday. Rising income levels, better employment rate and more people enrolling for Medicare,…
Coding Corner Answer: A Quiz on Modifiers
Take the challenge. 1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is…
Coding Corner Question: A Quiz on Modifiers
Which modifier is used when there is a separate and/or identifiable reason to bill for both an evaluation and management code and a procedure code? -25 -24 -51 -59 Which modifier is used to indicate that bilateral procedures were done on a patient? -50 -LT/RT Both a and b None of the above A 68–year-old…
7 Smartphone Tools for Rheumatologists
CHICAGO—Suleman Bhana, MD, a rheumatologist at New York-based Crystal Run Healthcare, calls himself a “technology nerd,” but judging by his review of tech tools at the 2018 ACR/ARHP Annual Meeting, you don’t have to geek out to embrace technology in your rheumatology practice. You just have to like simplicity and saving money. “We have a…
Possible MIPS Errors in 2019 Payment Adjustment
Recently, the Centers for Medicare and Medicaid Services (CMS) discovered an error in the implementation of the 2019 Merit-Based Incentive Payment System (MIPS) payment adjustment. It incorrectly applies adjustments to payments for Medicare Part B drugs and other non-physician services billed by physicians. Adjustments to affected claims will occur in the near future. According to the…
Update & Changes to the OIG Work Plan
Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity….
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