Although the National Organization of Rheumatology Managers (NORM) is always here to be a strong voice for our members, your independent voice is just as important. People often feel that the efforts of a large group are more effective than the efforts of individuals when it comes to fighting for an issue, but the truth is that our state and federal representatives want and need to hear from you. In addition, insurance companies want to know just how many people are affected by a particular issue, such as a change in billing policy. These people and organizations need to understand why you, as an individual, feel that the fight is important.
There are many things that you can do to advocate for an issue, and it does not take a lot of time to share your input. Face-to-face meetings with your representatives or their staff is the most effective way to get your message across. Some people, however, are apprehensive about meeting with their elected officials in person, and that is okay. Letters, phone calls, and e-mails are also powerful ways to communicate your thoughts. If you are not sure who your representatives are, simply go to www.congress.gov and click on your state. You will see a list of your House and Senate members in Congress. Their contact information will be available once you click on their names. To find your representative in Congress, go to house.gov and enter your zip code in the “Find Your Representative” box on the upper right-hand side of the webpage. Each state government’s website will have similar search features to locate your local representatives at the state level.
When communicating with your representatives—whether in person, by phone, or via e-mail—remember to be polite, professional, and respectful. If you are contacting them about a piece of legislation, inform them of the bill number and the subject. Try to be brief and get to your point quickly. Share with them why it is important that they act on the issue, let them know what you want them to do, and thank them for their time.
Consider becoming involved with organizations in your state to stay informed of the issues that affect you close to home. State issues will need to be fought by the members that are affected; however, NORM is always here to help you. There are also state representatives who can help you specifically with Medicare, Medicaid, Veterans Affairs, and self-funded plan issues.
You can also direct your efforts toward federal issues. Currently, an important issue on the federal level is the Centers for Medicare & Medicaid Services (CMS) proposal to make the Evaluation & Management (E/M) codes 99212 to 99215 and codes 99202 to 99205 reimbursed at the same rate.1 For rheumatology practices, this will mean a large decrease in our reimbursement, but not our overhead or time expenditures. Share with CMS and your representatives the potential impact of these changes on your practice.
The last issue comes from the insurance company UnitedHealthcare. As of December 1, 2018, UnitedHealthcare plans to no longer allow E/M code 96413 to be billed with abatacept, tocilizumab, golimumab, and vedolizumab.2 Their argument is that these drugs are not complex, like infliximab or rituximab. When E/M code 96413 was created, infliximab and rituximab were the only 2 infusible drugs available. Per the CMS manual, 100-04 Chapter 12 Section 30.5 (D),3 E/M code 96413 was created for monoclonal antibodies and other biologic response modifiers, which abatacept, tocilizumab, golimumab, and vedolizumab all fall under. This change could affect your practice through reduction of reimbursements, again, with no reduction in staff, administration time, supplies, time monitoring the patient, or documentation. CMS, insurance providers, and our elected officials need to understand that cutting physicians’ pay is not always the answer. It is vital that we encourage CMS to find other means of decreasing medical costs without reducing reimbursement to our physicians.
For more details on how to advocate for issues that affect your practice and patients, log into your NORM account at www.NORMgroup.org, and go to the Healthcare Policy tab.
- Centers for Medicare & Medicaid Services. Proposed policy, payment, and quality provisions changes to the Medicare physician fee schedule for calendar year 2019. July 12, 2018. www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes->medicare-physician-fee-schedule-calendar-year-3. Accessed September 14, 2018.
- UnitedHealthcare Network Bulletin. www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2018/network-bulletin/September-Interactive-Network-Bulletin-2018.pdf. Accessed October 1, 2018.
- Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual. 100-04 Chapter 12 Section 30.5 (D). www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html. Accessed September 28, 2018.