WASHINGTON (Reuters)—U.S. House Republicans are working on changes to their healthcare overhaul bill to provide more generous tax credits for older Americans and add a work requirement for the Medicaid program for the poor, House Speaker Paul Ryan (R-Wis.) said on Sunday. Ryan said Republican leaders still planned to bring the healthcare bill to a…
Undercoding Is Not an Audit-Proof Strategy in Medical Documentation
Overcoding is a common term used when discussing fraud and abuse in reporting procedures and services not supported by the actual work performed. Alternatively, undercoding—or failing to report the full extent of services or procedures provided—is an equally unsound practice and a compliance risk. In the world of quality reporting, undercoding can have damaging effects…
UnitedHealth Sued by U.S. Over Medicare Charges
(Reuters) – The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit against UnitedHealth Group Inc. that claims the country’s largest health insurer and its units and affiliates overcharged Medicare hundreds of millions of dollars, a law firm representing the whistleblower said on Thursday. “We reject these more than five-year-old claims and will contest…
Tips for Rheumatologists to Master Quality Measurement in Clinical Practice
WASHINGTON, D.C.—In 2017, rheumatologists will begin to track and report quality data for reimbursement under the the Medicare and CHIP Reauthorization Act of 2015 (MACRA). Panelists shared their tips on how to score more points under MACRA and utilize existing technology at a Nov. 14 session called Implementing Quality Measurement in Your Clinical Practice at…
OIG Releases 2017 Work Plan: A Summary
Each fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) puts out its Work Plan for the upcoming fiscal year to summarize its initiatives and priorities for new and ongoing work of HSS programs. Below is a summary of the key areas the OIG will focus on in 2017: Drug…
FDA Releases Biosimilar Guidance, Medicare Will Cover Infliximab-dyyb & More
The FDA has released guidance for the development of biosimilars, and Medicare will cover Inflectra (infliximab-dyyb) in 2017…
The ACR Insurance Subcommittee Advocates for Fair Payer Policies
The ACR is committed to advocating for appropriate coverage and payment policies. The volunteer members of the Insurance Subcommittee (ISC) lead this effort by representing the ACR and its membership to the insurance industry. The ISC engages payers to ensure their policies are clinically appropriate and promote patient access to high-quality care and treatment. The…
Stronger Malpractice Laws May Not Prevent Surgical Complications
(Reuters Health)—More aggressive malpractice climates don’t necessarily protect patients from surgical complications, a new study suggests. Supporters of medical malpractice laws that make it easier for patients to sue doctors say these protections are necessary to improve care. But in the current study, the risk of litigation didn’t translate into better outcomes, said study leader…
Top ACR Priorities in 2017 Include Drug Costs, MACRA
With a new federal administration and Republican-controlled Congress taking the helm in 2017, the ACR Government Affairs Committee has identified top legislative and regulatory priorities for the year. “The main priority is going to be helping represent the rheumatology community as Medicare is reformed, because the era of MACRA started Jan. 1,” says Angus Worthing,…
Insurance Subcommittee to the Rescue
Concerned about reimbursement for specialty drugs? Wondering if your patient can continue on a prescribed medication despite formulary changes? Unsure how to request a tier exception? No need to face these issues alone. The ACR has a resource that can assist with questions regarding coverage and payment policies for private insurers and Medicare. That resource…
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