Rheumatology Practice Management December 2017 Vol 5 No 6

Happy holidays and warmest wishes to you and your staff from the National Organization of Rheumatology Managers (NORM)!

In a press release from November 28, 2017, the American College of Rheumatology (ACR) is urging the Centers for Medicare & Medicaid Services (CMS) to reconsider proposals reducing health exchange insurance coverage, affordability, and patient choice.

In contrast to selling or outsourcing self-pay accounts receivable, lending institutions may provide 0% or low-interest rate loans to patients to cover their estimated responsibility. The institution has to have an adequate process and knowledge base to create estimates based on residual responsibility after the insurance payment.

We frequently receive questions regarding the infamous “nurse visit,” and what documentation Medicare or other payers expect to see when billing the Current Procedural Terminology code 99211. So, what are the exact medical documentations that would support billing the evaluation and management (E&M) code 99211 alone or with other billable services?

Under the new proposed framework, the Medicare Part B therapy caps would be repealed beginning January 1, 2018. The new bipartisan agreement will continue the manual medical review process and the requirement of an appropriate modifier for claims submitted above the new threshold if procedures are considered medically necessary.

This analysis evaluated the sustainability of clinical responses and improvements in physical function achieved on MONARCH at week 24 with continued sarilumab monotherapy, and assessed disease activity, physical function, and safety in adult patients switching from adalimumab to sarilumab.

The phase 3 TARGET study demonstrated that sarilumab (150 or 200 mg subcutaneously every 2 weeks [q2w]) plus conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) achieved clinical responses in terms of rheumatoid arthritis (RA) signs and symptoms and physical function compared with placebo in adults with active, moderate-to-severe RA who were intolerant of, or showed inadequate response to, tumor necrosis factor (TNF) inhibitors.