Practice Issues

Current Practice Issues

Issues Affecting Rheumatologists Now

Medicaid Tamper-Resistant Prescription Pads

Beginning on April1, physicians and health care professionals will be required to write all Medicaid prescriptions on tamper-resistant pads. These prerequisites will also apply to computer generated prescriptions.

The first phase of these new requirements must meet a minimum of one distinguishing tamper-resistant feature in one category as outlined by the Centers for Medicare and Medicaid below:

Category One: Industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form (e.g., prescription pad/paper printed on safety paper with a uniform background color).
Category Two: Industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber (e.g., prescription pad/paper quantities written out, rather than using numerals).
Category Three: Industry-recognized features designed to prevent the use of counterfeit prescription forms (e.g., prescription pad/paper including serial or sequential numbering).

The second phase of this requirement will begin October 1, when physicians and health care professionals will be required to have at least one feature from all three categories applied to all prescription pads and computer-generated prescriptions.

Some states have special requirements regarding tamper-resistant prescriptions, including California, Florida, Idaho, Indiana, Kentucky, Maine, New Jersey, New York and Wyoming.

For additional information about the tamper-resistant requirements and any special requirements in your state, visit the CMS Web site at www.cms.hhs.gov. If you have any further questions concerning this matter please contact Melesia Tillman, CCP, CPC at (404) 633-3777, ext. 820 or by e-mail at

New Advance Beneficiary Notice

On March 3, the Centers for Medicare & Medicaid Services replaced the general, lab and Notice of Exclusion from Medicare Benefits Advanced Beneficiary Notice. Physicians and other health care providers are required to begin using the new form when services are not expected to be covered by Medicare.
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-20007). 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 September 1, 2008. 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, CCP, CPC at (404) 633-3777, ext. 820 or by e-mail at

CMS EHR Demonstration Project

The Centers for Medicare and Medicaid Services is now seeking partners across the country who are interested in working with CMS to implement its electronic health records demonstration project in their communities.
Organizations seeking to partner with CMS to implement this demonstration in their regions must complete and submit a Medicare Waiver Demonstration Application by May 13, 2008. CMS will announce the selected communities in June 2008.
The EHR demonstration is one of many demonstrations across the country that the CMS Demonstrations Program Group is conducting to examine ways to improve care provided to Medicare beneficiaries. As many as 1,200 physician practices nationwide could be eligible for incentive payments of up to $58,000 per physician and up to $290,000 per practice over the five-year period of the demonstration. Incentives would be based on a practice’s level of EHR use and on the reporting and performance of 26 clinical quality measures.
Interested practices can learn more about the new EHR demonstration project on the CMS Web site and e-mail EHR_Demo@cms.hhs.gov or EHR_Demo_communityselections@cms.hhs.gov for more information about community selection.
If you have any further questions concerning this matter please contact Itara Barnes at (404) 633-3777, ext. 819 or by e-mail at .

Coding Changes for 2008 Healthcare Common Procedure Coding System Codes

There have been some Rheumatology HCPCS changes for 2008. In 2007 a decision was made to change a number of HCPCS codes, because the decision was made after the 2007 HCPCS book was published, the Centers for Medicare & Medicaid Services made these codes temporary Qcodes. A chart of the 2007 and 2008 HCPCS codes are listed below:

2007 Codes	2008 Codes	Description	Code Dosage	ASP Plus 6 percent Effective Jan. 1 thru Mar. 31, 2008
Q4083	J7321	Hyalgan or Supartz, inj	Per Dose	$102.06
Q4084	J7322	Synvisc, inj	Per Dose	$178.16
Q4085	J7323	Euflexxa	Per Dose	$110.87
Q4086	J7324	Orthovisc, inj	Per Dose	$171.37
Q4087	J1568	Octagam, inj	500 mg	$33.81
Q4088	J1569	Gammagard Liquid, inj	500 mg	$31.65
Q4091	J1572	Flebogamma, inj	500 mg	$32.61
Q4092	J1561	Gamunex, inj	500 mg	$32.88
Q4095	J3488	Reclast, inj	1 mg	$216.61

If you have any further questions or concerns, please feel free to contact Melesia Tillman, CPC the ACR coder on staff at 404-633-3777 ext 820.

The ACR and AMA Conducting Physician Practice Information survey

The American College of Rheumatology, the American Medical Association (AMA), and more than 70 other medical specialty societies, have worked together to coordinate a comprehensive multi-specialty survey of America’s physician practices. The purpose of the survey is to collect up-to-date information on physician practice characteristics in order to positively influence national decision makers. Thousands of practices will be surveyed in 2007 and 2008, from virtually all physician specialties to ensure accurate and fair representation for all physicians and their patients. Read more.

PQRI Measures – Rheumatology

To view and print a quick reference for the measures applicable to rheumatology in pdf format, click here. This list is an abridged version of the PQRI measures to see a complete list go to http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp#TopOfPage

ACR Responds to AHA Science Advisory on NSAIDs

In the March 13, 2007, issue of the journal Circulation, the American Heart Association published a Science Advisory on the "Use of Nonsteroidal Antiinflammatory Drugs: An Update for Clinicians." The ACR responded with a letter to the editor on March 14th, recently received a reply.

View the AHA advisory here.
View the ACR's Letter to the Editor.
View the AHA's response.

By the policy of the Editor of Circulation made independently of the American Heart Association, letters to the editor regarding AHA Statements and Guidelines are not published in Circulation.

The ACR Drug Safety Committee continues to monitor this and other issues related to drug safety. An updated patient education fact sheet on NSAIDs is now available for members to share with their patients.

ACR Tracks Member Concern about ANA Testing Results

ACR members have alerted the Regional Advisory Council about some concerns regarding the results of the antinuclear antibody test. The test is used to help screen for systemic lupus erythematosus, drug-induced lupus, and other diseases. Some ACR members are reporting false positives and negatives. Accurate results are crucial because treatment is determined according to the results of the study.

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.

MedPAC Study Report

Medicare's switch to a payment method designed to reflect actual market prices rather than inflated wholesale prices is successfully lowering spending on drugs in Part B of the program - those that largely can't be administered by patients themselves. That's the finding of a new report to Congress prepared by the Medicare Payment Advisory Commission, which also found no evidence that Medicare patients are having trouble getting access to the drugs because of the new reimbursement method, known as the Average Sales Price, or ASP, system.

Coding FAQs

ACR practice advocacy staff have prepared a list of frequently asked questions of questions related to coding issues, some of which were included in an issue of Practice View.
Expanded FAQ lists on these topics are also available:

Practice Advocacy Activities

ACR Staff and volunteers participate in a number of advocacy activities within the AMA, including the following committees:

AMA CPT Editorial Panel - The CPT Editorial Panel revises and updates the Current Procedural Terminology (CPT) code set that is the mandated standard of coding in the United States. This panel, composed of eleven AMA-nominated representatives from specialty societies and six additional representatives nominated by the Blue Cross Blue Shield Association, the Health Insurance Association of America, the Centers for Medicare and Medicaid Services (CMS) the American Hospital Association and the Health Care Professionals Advisory Committee (HCPAC), is responsible for providing annual updates to CPT to assure that it reflects current medical practice. Final changes to the CPT code set are published in a revised CPT coding manual each October and implemented January 1 each year. (New and changed CPT codes are forwarded to the AMA Relative Value Update Committee (RUC) for valuation no later than March of the year preceding their implementation.) In addition to the sixteen voting members, the CPT Editorial Panel receives input from the CPT Advisory Board, composed of specialty society representatives. The ACR is represented on the CPT Advisory Board by Robert Lloyd, MD.
AMA Relative Value Update Committee (RUC) - This committee of voting representatives from twenty-three specialty societies, the American Medical Association, the CPT Editorial Panel, the American Osteopathic Association, Health Care Professionals Advisory Committee (HCPAC) and the Practice Expense Advisory Committee (PEAC) provides recommendations on new and revised CPT codes to the Centers for Medicare and Medicaid Services (CMS). Annual recommendations regarding relative values (55% physician work and 42% practice expense components of RVUs) are derived through a process of code-level presentations and evaluations by RUC members. This work contributes to the successful maintenance of the resource based relative value scale (RBRVS) and provides a strong mechanism for physician input. The acceptance rate for RUC recommendations to CMS is consistently over 90%. Accepted RVUs are published in CMS' annual Medicare Fee Schedule. Eileen Moynihan, MD, represents the ACR as a member of the RUC Advisory Committee, a non-voting advisory group to the RUC. The ACR is eligible to hold rotating seats of Internal Medicine on the RUC Committee and has held this seat for 2 three-year terms since the RUC's inception in 1991.