The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…
Take the challenge. No, this claim is lacking proper documentation to be billed out correctly and requires querying the provider before submitting to the payer. First, a query is a written or verbal question concerning the documentation of what is being billed out and should be visible in the patient’s chart. If a query is…
An established, 66-year-old male patient with rheumatoid arthritis who was last seen in the office three weeks before returns to the office for an infliximab infusion. The patient reports mild pain in his right knee, right and left elbows. He rates the pain severity at a 3 on a 10-point scale. He denies any weight…
The operations management team in healthcare practices is expected to have an effective coding compliance program in place that is continually evaluated and reevaluated. To accurately assess the program’s effectiveness, several outcome indicators must be measured, including error rates in the provider’s documentation and the electronic health record (EHR). Due to increased scrutiny by the…
SAN DIEGO—In November, the Rheumatology Research Foundation honored 155 award and scholarship recipients at the Awards Celebration, an annual luncheon, held in conjunction with the ACR/ARHP Annual Meeting. The event celebrates the accomplishments of rheumatology professionals who have received funding from the Foundation. In congratulating the award recipients, executive director Mary Wheatley, CAE, IOM, emphasized…
If you read The Rheumatologist regularly, you may remember a column I wrote a few months ago about giving and receiving feedback (July 2017). I wrote it when I was finishing fellowship and looking back at six years of my graduate medical education. Now, as an attending physician who spends a considerable amount of time…
For Daniel Albert, MD, a rheumatologist with the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., some of his most defining medical experiences haven’t taken place within his practice, but in exotic locales such as a rainforest on the island of Borneo. One of many physicians across the world who volunteer their time and expertise on medical…
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…
Generating articles of incorporation, convening boards of directors, establishing nonprofit status: It’s no small feat to form a state rheumatology society, but with the right expertise, the results can be successful, according to the president of the Rheumatology Association of Minnesota and the Dakotas, Jody Hargrove, MD, who is in private practice with Arthritis &…
Greetings, advocates! Your government is back to work after ending a brief government shutdown by passing a short-term continuing resolution (CR), which will keep the government running at current funding levels into February. At some point, it would be great for Congress to pass a budget (instead of a CR) and to enact bipartisan plans…