Focus Rheums| ACR Convergence 2024 Previews

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Search results for: health insurance

Cigna to Eliminate Consultation Codes

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Cigna recently announced that they will discontinue payment for consultation codes later this year. As of Oct. 19, 2019, the payer will implement a new policy on Evaluation and Management (R30) that will deny claims billed with CPT codes for consultation services as not valid. Impacted CPT codes are 99241, 99242, 99243, 99244, 99245, 99251,…

4 Steps to Prevent Unnecessary Claims Denials

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Denied claims represent unpaid services, or lost or delayed revenue. Avoiding claims denials is the responsibility of everyone in a practice. Any deficiency on a focused strategy for denials management will have unfavorable resolutions to denials or lead to writing off the service without payment. With the changing landscape in practice management, the best route…

How Rheumatologists Can Better Partner with Social Workers

Linda Childers  |  

When Liz Morasso, LCSW, facilitates a Families Living with Rheumatic Diseases support group at Children’s Hospital Los Angeles, she empathizes with the struggles and challenges of her young patients. Ms. Morasso was only 16 years old when she was diagnosed with both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). She knows all too well…

The Prevalence, Incidence, Mortality & Costs of RA-Related ILD

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Interstitial lung disease (ILD) can be associated with rheumatoid arthritis (RA) with significant morbidity and mortality. An article in The Journal of Rheumatology focused on calculating the prevalence, incidence, mortality and costs to the healthcare system of RA-related ILD (RA-ILD).1 “RA is the most common of connective tissue diseases encountered by rheuma­tologists—affecting about 1% of…

Tap the ACR/ARP’s Practice Management Resources

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The ACR/ARP’s practice management division actively works to offer rheumatologists and their staff valuable, accessible resources to address practice issues. Our trained professionals provide the most up-to-date tools and resources to help improve practice efficiency and meet the myriad compliance obligations of the ever-changing healthcare landscape. The Practice Management Resource Center can assist with such…

ACR Volunteer Leaders Visit Capitol Hill, Lobby for 5 Issues

Ryan Basen  |  

WASHINGTON, D.C.—Dozens of rheumatology leaders met with more than 100 politicos on Capitol Hill in mid-May as part of the ACR’s annual Advocacy Leadership Conference. Armed with research and advocacy training concerning a handful of important issues, rheumatologists, rheumatology interprofessional team members, government affairs specialists and others met with federal lawmakers, legislative aides and correspondents….

Step Therapy Legislation in the States: Navigating a Varied & Complex System

Joseph Cantrell, JD  |  

As the practice of step therapy grows more pervasive throughout the insurance industry, the protocols become increasingly confusing to navigate. Steps vary from insurer to insurer based on plan type, and formulary differences are too often based on economic incentives rather than outcome-based medicine. Patients are often left hanging in the balance while physicians’ offices…

ACR Affiliate Society Council Spotlights State Efforts for Advocacy

Christopher D. Adams, MD, FACP, FACR, and Joseph Cantrell, JD  |  

So far it has been a busy year for the Affiliate Society Council (ASC). Forty-three states are now affiliated with the ACR through the ASC, and we may add another next year. Also, many state legislative sessions have wrapped up, so it’s a great time to provide an overview of the successes—and some of the…

ACR Pushes for Increased DXA Reimbursement

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Broken hips are among the most serious injuries incurred by older adults, and many fractures are preventable. According to the Centers for Disease Control and Prevention (CDC), approximately 300,000 people over the age of 65 are hospitalized each year for hip fractures, with women (who have lower bone density than men) experiencing three-quarters of all…

Coding Corner Answers: An Audit Record Request Quiz

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Take the challenge. C—When an insurance carrier requests the medical record for a service performed, the practice should send all pertinent information to support the medical necessity of that service. For example, if the drug requires that a patient first be tested for tuberculosis and the patient should be on methotrexate or leflunomide, the note…