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Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.
The transition to ICD-10 is only 42 days away. With the Oct. 1 conversion deadline fast approaching, providers and their staff are under the gun to complete system upgrades, training, and testing, and undertake necessary changes to workflow processes.
Following successful advocacy by the ACR and other groups, CMS has agreed to provide some reprieve for 12 months after implementation, as Medicare review contractors have been instructed to not delay Part B claims, whether automated or complex review, and to not reject claims based on use of an incorrect subcode, as long as the physician/practitioner uses a valid code from the right family of codes. Note: the family of code(s) is the first three characters of an ICD-10 category.
CMS as well as commercial payers require a valid code to be reported for reimbursement, and it will be important to follow the ICD-10 guidelines to complete the code set. While M05 is a correct category to identify rheumatoid arthritis with positive rheumatoid factor, ICD-10 coding guidelines indicate that at least five characters are necessary for this to be a valid/billable code. A sample of a valid code for RA with rheumatoid factor is M05.79 – rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement.
Understanding the coding guidelines and applying the most valid diagnosis code to your claim will minimize any negative impact on your practice’s financial and operational metrics. Below are five key things rheumatology practices can do for a smoother transition:
Finally, the ACR’s practice and coding staff are available to assist with your coding and billing needs. We will monitor CMS and all commercial payer policies in an effort to minimize any financial and procedural impact that may affect your practice. Our goal is to ensure your practice remains profitable and compliant, and continues to focus on patient care.
For questions or information on coding and billing, contact the ACR practice management department at email@example.com.
During the month of August, Congress takes their annual summer recess and returns home for district work periods. This is a great opportunity to meet with lawmakers in their district offices and around the community. RheumPAC also helps provide an opportunity to meet with your member by sponsoring attendance at local fundraisers.
This August, RheumPAC will be supporting members in Texas, Maryland, Washington State, Georgia, Wisconsin, and more.
Our RheumPAC dollars go even further when presented by actual constituents, providing a unique opportunity to share issues facing rheumatologists, health professionals, and patients, with those who can impact the healthcare landscape. If you are interested in attending a local event with your member of Congress, please contact RheumPAC@rheumatology.org.
Rheumatologists who have not been members of the AMA, or have let their membership lapse, should join the AMA now for 2015 so rheumatology can remain involved in steering the direction of the AMA. Visit AMA or contact ACR staff at firstname.lastname@example.org for assistance in becoming an AMA member or renewing your membership. If you are already an AMA member, please make sure you have designated the ACR as your representative society. Why is AMA membership important to rheumatologists?
We need your help to maintain rheumatology’s seats at the AMA policymaking body, the House of Delegates, as well as rheumatology’s seat at the table for the RUC and other vital decision-making and informational aspects of organized medicine. The AMA surveys rheumatology’s membership in the AMA annually and adjusts rheumatology’s representation accordingly. AMA House of Delegates’ representation is based on the number of ACR members who also maintain a membership with the AMA and the number of joint ACR/AMA members who designate the ACR as their representative society. Rheumatology will receive one delegate per 1,000 members and one for any increment over 1,000. Therefore, it is imperative that all ACR members consider joining the AMA or renewing your membership for 2015.
The ACR has an active and effective delegation to the AMA representing rheumatologists’ interests. At the last meeting in July, the ACR led action on these issues:
ICD-10: The HOD adopted policy that the AMA will ask CMS and other payers for a safe harbor "grace period" for the ICD-10 transition, based on existing policy the ACR and partners put in at previous meetings. Additionally, the AMA will aggressively promote this implementation compromise to Congress and CMS (this is new, inserted by the reference committee after testimony and the amendment offered by the ACR and others). This is a major focus of ACR advocacy, specifically with the legislation introduced by Rep. Diane Black (H.R. 2247).
The ACR was successful in having the HOD adopt policy regarding the Value-Based Modifier and Flawed Drug Cost Attribution. The ACR-drafted Resolution 236 asked that the AMA work with CMS to modify VBM cost attribution with regard to drug costs, to ensure the cost calculation does not unfairly disadvantage certain providers. The VBM will remain part of the future Merit-Based Incentive Payment System (MIPS) called for by the MACRA, the legislation that repealed the SGR. Our Resolution 236 was co-sponsored by the American Academy of Allergy, Asthma & Immunology (AAAAI), American Academy of Dermatology, American College of Gastroenterology, and American Society of Clinical Oncology.
The ACR co-sponsored Resolution 505 along with the dermatology caucus members regarding the difficulties rheumatologists often face obtaining coverage for patients for off-label use of medications. The HOD amended current policies and resolved to advocate that the FDA work to establish a process whereby the official drug labeling can be updated in a more expeditious fashion when new evidence becomes available affecting the clinical use of prescription medications and that evidence-based standards or peer-reviewed medical literature can add to legacy information contained in official drug labeling statements to guide drug administration and usage.
In another effort with the dermatology caucus, we sponsored Resolution 702 regarding Access to In-Office Administered Drugs. This strengthens AMA policy that we had previously brought forward regarding this issue.
These are just a few examples of what the ACR is doing for you at the AMA, from a recent HOD meeting. The ACR’s activity and impact at the AMA House of Delegates are only possible because of ACR members who are also members of the AMA. It is important that rheumatologists take a moment today to continue to join and renew their AMA memberships to allow this work to continue and to keep the ACR part of the AMA federation. It is a critical piece of our overall advocacy strategy, and we thank you for your help.
Visit AMA or contact ACR staff at email@example.com for assistance with your AMA membership.
In terms of getting our message heard in Washington, D.C., rheumatology faces a David vs. Goliath battle on several levels. Many industries have far greater resources, use multiple lobbying firms, and have advertising and lobbying budgets that eclipse ours significantly. Rheumatology is far smaller than most other medical specialties; our membership is a small fraction of the surgeons, cardiologists, and family physicians. Also, many issues important to our specialty are not particularly germane to all of our colleagues. However, despite these roadblocks, we actually have a fairly good track record in Washington.
One way we have succeeded is through the development and use of coalitions. The ACR is a leader of several coalitions that promote causes important to us. The ACR serves as the convener of the Cognitive Specialty Coalition, which includes other internal medicine specialties that have far different goals from those specialties heavy in procedures (neurology, endocrinology, infectious diseases, psychiatry, etc.). The Coalition for Accessible Treatments, which the ACR co-founded with the Arthritis Foundation, supports our ability to get our patients expensive medications that are vital to their well-being and disease control at a reasonable price. We also team up with many patient advocacy groups, such as the Arthritis Foundation and many others, to promote a variety of issues important to our ability to provide the best care to those in need. Combining many voices results in our message being heard that much better.
The legislative branch also has coalitions that are important to promoting our causes. We approach caucuses that already have some knowledge of our issues in the hopes that they can explain our issues to their colleagues who are not acquainted with the problems we and our patients face.
The Congressional Arthritis Caucus is actively promoting the Patients’ Access to Treatments Act (PATA), which aims to keep biologics affordable for our patients. The Congressional Academic Medicine Caucus (CAMC) is an informal, bipartisan group of members of Congress dedicated to advancing legislation designed to strengthen medical education in the U.S. We also routinely approach other caucuses if there is an issue that would be important to the members.
Our involvement with the various coalitions has made a difference. Rheumatologists are no longer believed to be feng shui specialists in the halls of Congress. As we make stronger ties with other like-minded groups, we can expect to see many more successes in the future. I hope you will be a part of these efforts by signing up for the ACR’s Key Contacts program.
Chris Morris, MD
Member, RheumPAC Committee