New members include rheumatology state societies, specialty partners in gastroenterology and patient-facing organizations representing digestive and inflammatory diseases. The ACR and coalition partners are strategizing additional steps to ensure practices receive adequate reimbursement for biosimilars.
ACR Advocates with Payers Against Insufficient Reimbursement for Biosimilars
The ACR is engaging with payers regarding formulary requirements that would leave practices underwater when treating patients with rheumatic diseases.
Advocacy Highlights & Fall Treats: Reflections from the GAC Chair
Outgoing Government Affairs Committee Chair Blair Solow, MD, offers advocacy updates from 2022 and seasonal reflections on how to stay focused on efforts that matter when faced with daunting challenges.
Rheumatology Coding Corner Answer: Prolonged Service without Direct Patient Contact, Part 2
Take the challenge. CPT codes 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour 99359—each additional 30 minutes (list separately in addition to codes for prolonged service) Coding Rationale No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting…
Rheumatology Coding Corner Question: Prolonged Service without Direct Patient Contact, Part 2
An established, 66-year-old male patient is seen in the office for a follow-up visit for his fibromyalgia. The physician makes the decision to prescribe venlafaxine for anxiety and depression, and gabapentin for nerve pain. After the visit, the physician informs his medical assistant (MA) to contact the patient’s insurance carrier because venlafaxine requires a prior…
Refocus Your Practice with Invigorating Sessions at 2017 ACR/ARHP Annual Meeting
The landscape of practice management and coding methodologies continues to be challenging in the current healthcare environment, and rheumatology practices must maintain focus on managing an effective and efficient practice. Join us at the 2017 ACR/ARHP Annual Meeting, Nov. 3–8 in San Diego, and gain knowledge and understanding of best practices in an ever-changing environment…
How to Document a Patient’s Medical History
The levels of service within an evaluation and management (E/M) visit are based on the documentation of key components, which include history, physical examination and medical decision making. The history component is comparable to telling a story and should include a beginning and some form of development to adequately describe the patient’s presenting problem. To…
How MACRA Has Affected Physician Compliance
In recent years, providers and practice groups have been worrying about Meaningful Use (MU) and gaining knowledge on using certified electronic health record (EHR) technology to avoid payment penalties, earn incentives and increase practice efficiency. Now, with the release of the final rule for MACRA payment reform, physicians will have two options for payment paths:…
Insurance Subcommittee Responds to Health Plan Complaints
The ACR Insurance Subcommittee (ISC) regularly engages with insurance companies to discuss concerns raised by ACR members and advocate for appropriate coverage and payment policies. The ISC has gotten off to a busy start in 2017, working on a variety of patient access and reimbursement issues. Two recent issues the ISC has taken action on…
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…
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