Different parts of Medicare cover different services. For outpatient prescription drugs, Medicare has two distinct programs with a maze of complex policies. Most physicians along with Medicare patients, retail pharmacies, Medicare drug plans as well as Medicare Advantage health plans continuously struggle with navigating Medicare drug coverage under Part B and Part D. There are…
New York Orders UnitedHealth to Pay $100,000 to Settle Antitrust Probe
WASHINGTON (Reuters)—The New York Attorney General has ordered UnitedHealth Group to pay a $100,000 fine after an investigation found the insurance provider engaged in anti-competitive practices involving elder and long-term care products, according to a person familiar with the matter. The settlement, which was signed late Wednesday, centers on efforts by UnitedHealth to force nursing…
Preparing for the Transition to ICD-10
The transition to ICD-10 is not just another yearly diagnosis codes update; it is a complete overhaul. This not only will affect providers, but also all payers, vendors and stakeholders are being affected by the expanded ICD-10 code sets through medical coding operations, software systems, reporting, administration, registration and more. With approximately 20 days before…
ACR Seeks Members’ Help to Boost AMA Representation
Rheumatologists who have not been members of the American Medical Association (AMA), or have let their membership lapse, should strongly consider joining now for 2015 so rheumatology can remain involved in steering the direction of the AMA. Call the AMA at 800-262-3211 and specify that you want to join for 2015, or contact ACR staff…
AFIRM Act of 2015 Could Benefit Rheumatologists
New legislation has the potential to streamline the audit process for Medicare and Medicaid, taking a burden off small rheumatology practices…
One-Year Transition Period May Ease the Pain of ICD-10
As the Oct. 1 deadline to transition to ICD-10 approaches, the CMS has released multiple resources, including a joint guidance statement with the AMA that details one year of claims leniency to help physicians adjust to the new coding system and smooth the transition process…
CMS Acts on the ACR’s Requests & Announces ICD-10 Grace Period
In a win for the ACR and rheumatologists, for one year after the mandatory ICD-10 implementation on Oct. 1, 2015, CMS will not deny claims on the basis of incorrect ICD-10 sub-codes.
Rheumatology Community Applauds CMS Guidance Providing ICD-10 “Safe Harbor” Period, Encourages Further Action to Ensure Responsible Transition
ATLANTA, Ga.—The American College of Rheumatology (ACR) today praised the Centers for Medicare and Medicaid Services (CMS) for issuing new guidance to provide a 12-month “safe harbor” period for physicians following the Oct. 1 implementation of the ICD-10 code set. The ACR has led legislative and grassroots efforts to responsibly address the transition to the…
Proposed Medicaid Rule May Benefit Rheumatologists
The Centers for Medicare & Medicaid Services is attempting to update the reimbursement process for Medicaid, which might relieve administrative burdens on specialists and improve access to services.
Many U.S. Hospitals Mark Up Prices 1,000%
NEW YORK (Reuters)—Even the astronomical price markups that consumers regularly pay for, say, wine in restaurants pale beside those in some U.S. hospitals: The price for procedures is often 10 times the cost, according to a study published Monday in the journal Health Affairs. Of the 50 hospitals with the highest markups, 49 are for-profit,…
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