The Red Flags Rule

The immunofluresence methodology test to screen for ANAs is still available for use, and the ACR ANA taskforce is advising clinicians to continue using this test—rather than solid phase assays—as it believes it to be the best way to screen for ANAs.

Immunofluoresence Methodology Still Available In the Detection of Antinuclear Antibodies

The immunofluresence methodology test to screen for ANAs is still available for use, and the ACR ANA taskforce is advising clinicians to continue using this test—rather than solid phase assays—as it believes it to be the best way to screen for ANAs. During the past decade, commercial clinical laboratories have adopted a wide variety of new tests, including solid phase assays, for the detection of antinuclear antibodies. Some commercial laboratories have adopted these new assays to replace traditional “gold standard” indirect immunofluorescence tests to screen for ANAs. The new solid phase assays detect up to 13 specific autoantibodies, while indirect immunofluorescence using Hep-2 cell substrate detects more than 100 clinically-relevant autoantibodies, which is why the task force is making its recommendation.

Over the past two years, the ACR ANA Taskforce (which was established as a result of the growing concerns ACR members had over this topic) has carefully reviewed the available literature concerning newer, solid phase assays for the detection of ANAs. These solid phase assays were developed to detect a limited number of specific autoantibodies in the serum of patients with autoimmune diseases. Although some of these tests have been approved by the FDA for use in screening for antinuclear antibodies, the taskforce did not find sufficient evidence to conclude that solid phase screening assays are equivalent to indirect immunofluorescent assays for the detection of antinuclear antibodies.

The taskforces is alerting the membership that ANA by IFA is still available. The code for Quest is 38318. Quest has another test ANA choice (tm) 19946, but this is a solid assay, and it is not recommended as a screening test for ANAs. LabCorp also has an ANAIFA code (164947).

For more information about this topic, read “Know Your Labs” in the February 2009 issue of The Rheumatologist or read the ACR’s position paper encouraging commercial laboratories to utilize the IFA test to detect ANA. You can also join the conversation by joining the ACR’s advocacy listserve or contact the practice advocacy department at (404) 633-3777.

By statute, a protest requires CMS to issue a stop-work order that should remain in effect until the protest is resolved. NAS expects a decision from the GAO by May 6, although an earlier resolution to the protest is possible.

CMS announced the implementation period of the NAS J6 Medicare Administrative Contractor A/B contract on January 7. On the transition date, NAS began processing Part A and Part B Medicare claims for Minnesota, Wisconsin and Illinois.

Physicians can send letters of support or concerns in regards to the formal protest directly to the GAO at the address below:

Government Accountability Office
441 G St., NW
Washington, DC 20548

Please continue to check the ACR Web site for important updates regarding this implementation, or visit the GAO Web site and put "Wisconsin" in the protest field to follow the activities of this action.

For additional information, contact Antanya Chung at org or (404) 633-3777, ext. 818.

The United Health PDP program uses clinical practice information with the intention of assisting physicians in the continuous practice improvement, as well as assisting consumers in making more informed and personally appropriate choices for their medical care.

You can now view your individual assessment reports on the UHC Web site, using the user ID and password provided in your assessment results letter.

This site provides basis information on the premium program, the detailed methodology used for the assessment and other materials to assist physicians in learning more about the program including FAQs and the process for requesting reconsideration. An interactive course (offering continuing education credits) that provides detailed information about the premium program’s methodology and process can also be found on this site.

Physicians who wish to appeal their rating in United Healthcare’s Premium® Designation Program must visit https://ereports.uhc.com/ReportCard and log in using their ID and password, which appears on the letter they received from UHC announcing their rating. Requests for reconsideration must be submitted in writing or electronically and include the Designation Detail report, with your comments, and the signed attestation.

If you did not receive the Premium Designation Program (PDP) letter that United Healthcare (UHC) mailed to PDP-participating physicians on December 23, 2008:

1. The rheumatologist should check to see if he/she has a contract with UHC.

2. If the rheumatologist contracts with UHC, he/she should check the list of states below where the PDP is available:

   AL, AR, AZ, CO, CT, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, MI, MS, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, WA, WI and WV. Please note: The program may not be available in all parts of each state.

3. If the rheumatologist contracts with UHC, practices in one of the states where the program is offered, and did not receive a PDP letter from UHC, he/she should use the following resources to obtain a fax copy or email of the letter:

   Toll-free phone: 866-270-5588

   E-mail: unitedpremium@uhc.com

If UHC receives a request for reconsideration of a physician ranking by January 27, 2009, they will not publish or use that ranking until the reconsideration has been resolved. However, physicians may still file after that date and any changes in the physician’s ranking, resulting from the reconsideration, will be reflected in the program and their Web directory.

To access their data and file for reconsideration, physicians should go to https://ereports.uhc.com/ReportCard. Physicians will need their ID and Password contained in the UHC letter.

For more information, you can contact UHC direct at (866) 270-5588 (this number should be used only by physicians regarding their rating in the PDP), or contact Itara Barnes in the ACR’s Practice Advocacy department.

Listed below are the CPT code changes:

*Do not report 96360 or 96361 if performed as a concurrent infusion service.  If saline is used to flush out a drug when the patient is having an allergic reaction; the codes can be billed along with a modifier 59.

For further information or questions concerning the code changes, you may contact Melesia Tillman, CPC, CCP at (404) 633 -3777 ex. 820 or via email at .

Each practice can have an appropriate staff person be designated as the security official. This individual can then register for access through the new CMS security system Individuals Authorized Access to CMS Computer Services – Provider Community.

There has been some issue of individual physicians registering incorrectly. Individual professionals, who will not have any staff accessing this system, should register as an individual practitioner and not as an organization. If your office did not submit 2007 PQRI quality measures; please do not register.

More information about registering in IACS and accessing 2007 PQRI Participant Feedback Reports will soon be posted on http://www.cms.hhs.gov/PQRI. If you have any questions or concerns about this matter please feel free to contact Melesia Tillman CPC, CCP at 404-633-3777 ext. 820 or at .

CMS has now clarified those requirements for printed prescriptions generated via EMR or ePrescribing systems and has determined that compliance for these prescriptions within Category 1 (copy resistance) can be achieved without using special paper. Special paper can still be used for printing, but the overall guidance from the NCPDP and CMS to State Medicaid Directors is that copy resistance can be met with using micro printing or a printed void pantograph. These features enable practices to avoid the high cost of acquiring special tamper-proof prescription paper. Read More >

If you have any additional questions or concerns regarding Tamper Resistant Prescriptions or ePrescribing, please contact Itara Barnes at or (404)633-3777.

The ACR, the AMA, and more than 70 other health care professional organizations have worked together to coordinate this comprehensive multi-specialty survey of America’s physician practices.

The results will be used to positively influence national decision makers to ensure accurate and fair representation for all physicians and patients, and to articulate the challenges of running a practice that provides expert patient care, while operating a business that is sustainable.Of particular importance is the section of the study pertaining to practice expenses and the amounts that are attributable to you.

In addition, The Centers for Medicare and Medicaid Services has indicated it will use the results of this study to help determine physician payment, which is a topic of great importance to the rheumatology community.

The survey firm dmrkynetec  is currently contacting randomly selected physicians and practice managers to collect responses. Please watch for this survey and do your part in completing it in a thorough and accurate manner if selected to represent our specialty.

For more information, contact Antanya Chung at (404) 633-3777, ext. 818 or by e-mail at .

Physician Practice Information survey FAQ

Read More >

The revised ABN forms—newly titled, “Advance Beneficiary Notice of Noncoverage”— will replace the existing ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-2007). For patients to be held responsible for non-covered Medicare expenses, rheumatology practices are required to have a signed and dated ABN in the patients file prior to any service provided by a physician or heath care professional. 
The ABN:

• Replaces both the ABN-G and ABN-L
• Includes a mandatory field for cost estimates of the services at issue
• May be used for voluntary notifications in place of the Notice of Exclusion from Medicare Benefits
• Offers an option where beneficiaries may choose to receive a service and pay for it out-of-pocket, rather than submit a claim to Medicare

CMS is allowing a transition period for use of the revised form and instructions. Accordingly, providers and suppliers must begin using the revised ABN no later than March 1, 2009. Visit the CMS Web site for additional information or to download the revised ABN form.

If you have any further questions concerning this matter please contact Melesia Tillman, CPC, CCP at (404) 633-3777, ext. 820 or by e-mail at

RAC member John Goldman, MD, recently researched the issue to assist members in obtaining accurate ANA test results. Quest Diagnostics generally screens ANA tests with ELISA, not Indirect Fluorescent Antibody. If Quest Diagnostics receives a positive from the ELISA test, they will reflex to IFA. However, physicians can request an IFA by ordering 249X and adding “Force Reflex” to the order. This will alert that laboratory to perform both studies.

LabCorp screens ANA tests with Athena Beads. The Athena Bead test has different colored beads, each one coated with different ANA subsets: SSA, SSB, Sm, RNP, Scl-70, Jo-1, Centromere B, dsDNA and Histone. Physicians would receive a positive report if any of the subsets are over 100. Physicians may request that the ANA be performed using IFA by ordering 164947.

When Dr. Goldman reviewed the literature, he determined that Athena Beads and ELISA ANA testing are somewhat comparable but neither is as reliable as IFA. The Regional Advisory Council wants to make sure ACR members are informed about ANA testing to make the appropriate decisions for their practice. IFA screening for ANA continues to be the gold standard for ANA testing. If you have additional questions or concerns, please feel free to contact the Melesia Tillman in the ACR Practice Advocacy Department via e-mail: or phone (404) 633-3777.