A 73-year-old female established patient with rheumatoid arthritis affecting multiple joints and with positive rheumatoid factor returns to the office for an infliximab infusion. She denies any fevers, cough, dyspnea or concurrent illness. She has joint pain of 6 on the pain scale. She is on an NSAID, weekly methotrexate subcutaneous injections, folic acid and…
UnitedHealthcare Implementing Risk Adjustment Audit Program
Beginning in June 2018, UnitedHealthcare (UHC) will implement their risk adjustment data validation (RADV) audit program. UHC states that through the mandatory requirement by the U.S. Department of Health and Human Services (HHS), Medicare Advantage health plans will be reviewed for supporting medical documentation to check for accurately reported patient data. UHC will send requests…
Current Graduate Medical Education Can’t Meet Future Needs
In 2005, an ACR Workforce Study estimated the adult rheumatology workforce to be 4,946 providers and projected growth of only 1.2% by 2025, resulting in a projected deficit of 2,576 rheumatologists considering the estimated need. According to the 2015 Workforce Study, between 2005 and 2015, the percentage of internal medicine residents entering rheumatology has remained…
Avoid Errors: Insights into Ensuring Accurate Data in EHRs
With the increasing use of electronic health records and quality measure reporting requirements, data collection has become crucial for rheumatologists. But how do clinicians prevent human error and ensure data accuracy?
Avoid Billing Risks for New vs. Established Patients
When coding evaluation and management (E/M) services provided to a patient, one of the most persistent concerns is whether a patient is new or established to the practice. Although this may seem like a simple coding answer, the distinction is an important one, because it enables providers to appropriately bill and receive reimbursement correctly. E/M…
Rheumatology Coding Corner Answer: Billing for an Inflectra Infusion
Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…
Rheumatology Coding Corner Question: Billing for an Inflectra Infusion
A 68-year-old female patient returns to the office for a second round of Inflectra (infliximab-dyyb) infusion for her rheumatoid arthritis with rheumatoid factor of multiple joints without organ or systems involvement. She reports pain, stiffness and swelling in her left and right knees and right elbow and rates the pain at a 9 on a…
3 Ways to Improve How You Work with Doctors from Other Specialties
Many trainees tell me they’re attracted to rheumatology because it demands becoming a complete physician. We need knowledge of the brain, eye, lung, kidney, liver, skin, bones and vascular system to be effective rheumatologists. And because our diseases are frequently multisystem diseases, rheumatologists must be the quintessential collaborators. For more than 30 years, I’ve directed…
The Social Workers’ Role in Rheumatology Care & Patient Advocacy
Patients with rheumatic disease require a team of specialists working together to meet the patient’s needs. Social workers can advocate for these patients and play a variety of other roles to help them manage their disease…
At the Table: ACR Meets with MedPAC
The Medicare Payment Advisory Commission (MedPAC) makes recommendations to Congress on Medicare policy including physician payments and patient access issues. These recommendations can directly impact rheumatology care coverage and rheumatologist reimbursement. Representatives of the ACR and partners recently met with new MedPAC Executive Director James E. Mathews, PhD, to discuss appropriate recognition of rheumatology care…
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