Mark Post, North Texas Joint Care Dallas, TX

This article is focused on high-stakes claims appeals of the utmost difficulty, rather than the routine process. In rheumatology, such high stakes inherently will always entail a buy-and-bill specialty medication, such as a biologic or hyaluronan; to our newer colleagues, those medications are normally billed as J codes. Read More ›

Carolina Arthritis Center sits in a welcoming brick building in the city of Greenville, NC. Approximately 90 miles west of the North Carolina coast, Greenville is home to East Carolina University, Vidant Medical Center, and numerous businesses, medical practices, and industry. While the city promises the conveniences of urban life, it also boasts plenty of opportunities for outdoor fun, and prosperous farmlands are a short drive away. Read More ›

We are all familiar with the notion of appealing insurance denials of medication coverage, claims, line item issues of claims, and precertifications for procedures such as biopsies and imaging. While following payer protocols may eventually resolve an immediate issue, the necessary investment of time to resolve these matters becomes frustrating and daunting. An examination of practice–payer relations shows that perhaps a more comprehensive evaluation of this system is needed. Read More ›