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Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.
Gout patients unable to afford their colchicine prescription will soon see lower prices thanks in part to an amicus curiae brief filed by the ACR before the Federal Circuit.
The ACR is committed to supporting patient access to safe, effective and affordable rheumatology care and a recent case threatening this access captured our attention. The ACR's primary concern in its amicus curiae brief involved the single-source availability of colchicine's potential to negatively impact public health and the practice of medicine.
While we do not yet know the generic pricing, the ACR is pleased that it was able to play an important role in the reintroduction of competition to the colchicine market, which will drive down the cost of colchicine prophylaxis therapy for rheumatology patients nationwide.
Read the full details and view the media release here.
The ACR continues to meet with lawmakers in support of any efforts to ease the burden of ICD-10, from further delay to safe harbor periods. As CMS prepares for implementation of ICD-10, it is continuing its schedule of acknowledgement testing and end-to-end testing.
The Centers for Medicare and Medicaid Services (CMS) reported late last month there was an 87 percent acceptance rate during November's ICD-10 acknowledgement testing week. During the testing week, CMS received almost 13,700 claims submitted from more than 500 providers, suppliers, billing companies and clearinghouses. CMS verified the test claims had a valid diagnosis code matching the date of service, a valid National Provider Identifier, and an ICD-10 companion qualifier code to allow for processing of the claims. CMS reported that many testers intentionally included errors in their claims to make sure the claim would be rejected and CMS did not report any issues with the Medicare FFS claims system. Read CMS's full report >
Mark your calendar for upcoming acknowledgement testing weeks with CMS on March 2–6 and June 1. Registering for acknowledgement testing gives submitters access to real-time help desk support and allows CMS to analyze testing data. Contact your Medicare Administrative Contractor (MAC) for more information about acknowledgment testing.
While the goal of acknowledgement testing is to submit claims with ICD-10 codes to confirm if your claims will be accepted or rejected, it is more important for providers to participate in end-to-end testing. End-to-end testing takes the claims submission one step further, as this will process claims through all the Medicare system edits to produce and return an accurate Electronic Remittance Advice (ERA).
CMS extended the deadline for providers to volunteer for the April end-to-end testing until January 21. Contact your Medicare Administrative Contractor or register with the Common Electronic Data Interchange (CEDI) for the testing week. CMS is offering approximately 2,550 volunteers the opportunity to participate in end-to-end testing with their MACs and the CEDI contractor in April and July.
For questions about testing or ICD-10 training in your area, contact Antanya Chung at firstname.lastname@example.org or 404-633-3777, ext. 818.
The ACR recently commented on a review addressing the efficacy of a variety of pharmacologic interventions for knee osteoarthritis. The review was funded by the Agency for Healthcare Research & Quality (AHRQ) at the request of CMS.
The review examined randomized trials of adults with knee OA and the comparative effectiveness of hyaluronic acid injections, intra-articular corticosteroids and a number of other oral medications compared to placebo.
The ACR recognizes that there has been debate about the efficacy of hyaluronic acid injections. Please see the AHRQ review, as well as the ACR position on intra-articular hyaluronic acid injections in knee OA. You can also view ACR position statements on a wide range of other access and coverage topics.
It is no secret that the administrative burdens on rheumatologists and rheumatology health professionals are exploding and nearing an untenable state. The “alphabet soup” of PQRS, VBM, MU2 and ICD-10 requires time that should be devoted to patient care instead of negotiating the EHR-based pathway of compliance with regulations.
This threatens the economic viability of many rheumatology practices, but is especially onerous for solo or small groups. In my volunteer work with our state society and the ACR Government Affairs Committee, I have the privilege of meeting lawmakers who understand our dilemma and are trying to provide relief.
Rep. Renee Ellmers (R-NC) from my home state has re-introduced the Flexibility in Health IT Reporting (Flex-IT) Act (H.R. 270) in the new Congress, working with her colleague Rep. Ron Kind (D-WI). This will allow attestation for MU2 over a 90-day period instead of mandating reporting over the entire calendar year, providing an opportunity for more rheumatologists to be compliant with the MU2 requirements and avoid financial penalty.
Please join me in thanking Rep. Ellmers and asking other members of Congress to sign on to the bill. You can visit the ACR Legislative Action Center to learn more about this important bill and other issues facing rheumatologists, and to send a message to your member asking that they support the Flex-IT Act. Your voice makes a difference.
Sean Fahey, MD
Member, ACR Government Affairs Committee
President, North Carolina Rheumatology Association