ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…
In the new year, ACR advocacy staff will be working to advance bills to reform step therapy, prior authorization and more in state legislatures across the country.
Issues related to the costs and insurance coverage associated with rheumatologic care can be complex and overwhelming for patients. Here’s how one private practice addresses the financial side of treatment with its patients…
Changes announced at the beginning of October have now been delayed for Actemra, Benlysta, Cimzia, Orencia and Simponi Aria, but changes to the Stelara policy remain in effect.
The House of Delegates (HOD) is the policy-making body of the American Medical Association (AMA), and twice a year, representatives of all seated specialties, service societies and state medical associations review hundreds of resolutions to determine which will become AMA policies. Once those policies and priorities are determined or updated, we benefit from the AMA…
This year, the American Medical Association (AMA) convened its annual House of Delegates (HOD) meeting June 8–12 in Chicago to discuss emerging and public health issues. Among the many policies and practices discussed: two resolutions put forth by the ACR on behalf of ACR and ARP members, one concerning prior authorization and another concerning step…
Involving pharmacists in the management of chronic diseases benefits patients, says Wendy Ramey, BSPharm, RPh, CSP, a clinical pharmacy specialist in rheumatology at the University of Kentucky, Lexington. She knows this personally. As someone with rheumatoid arthritis (RA), Ms. Ramey knows pharmacists can play an important role in patient education and encouraging adherence to medications….
With a number of new legislators and new governors sworn in this month, 2019 promises to be an exciting year for state-level rheumatology advocacy. “Now is the time to reach out and share our top issues with new legislators in your state,” suggests Joseph Cantrell, ACR senior manager of state affairs. 2019 Priorities ACR Affiliate…
In an already complicated reimbursement landscape, claims denials can potentially pose a serious issue to the financial revenue for rheumatology practices. Denials are not only highly prevalent in the healthcare environment, but also costly to appeal, which affects overall reimbursements. According to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting…
Unfortunately, prior authorization continues to be a burden for providers, practices, and patients. Effective Jan. 1, 2019, UnitedHealthcare (UHC) will retire fax numbers used for medical prior authorization (PA) requests. After this date, UHC will require PA requests to be submitted through their Prior Authorization and Notification tool. Providers who can’t submit requests electronically may…