RheumWATCH Archives


Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.


UnitedHealthcare Clinical Data Request

UnitedHealthcare Clinical Data Request

The ACR recently spoke with UnitedHealthcare in response to the notice in their April bulletin requesting clinical data effective July 1. Many ACR members expressed concerns regarding the scope of this request and its administrative burden to practices.

According to United’s bulletin, the protocol would require providers to submit “all clinical data – including, but not limited to, laboratory testing results … to UnitedHealthcare within 30 days of the date of service.”

United assured the ACR that the initial scope and impact of this protocol are significantly more limited than the April bulletin suggests. They initiated this program in response to requests for data from CMS for purposes of star ratings. In phase one, United is only collecting HbA1C values for Medicare patients. United will reach out directly to those providers who are impacted during phase one and review options for data submission.

Please note, if an HbA1C test is performed by an outside lab, United will communicate directly with the laboratory, not the ordering physician. (In their bulletin, the term “provider” refers to an entity that performs a billable service; this is not the doctor who ordered the lab test unless the test is performed in-house.)

In accordance with CMS (and other agencies’) reporting requirements, it is possible that future requests for data will have a more direct impact on rheumatologists. So far, United has not shared any plans for future phases of their program beyond the HbA1C initiative.

The ACR will continue to monitor the implementation of this protocol and its effect on our membership. Please be advised that members do not need to take any action at this time unless they are contacted by United. If you are asked to provide data outside the scope of the program as described above, please contact us at practice@rheumatology.org.

Florida Society of Rheumatology Supports Rheumatology Research Foundation

The Florida Society of Rheumatology held their 2015 Annual Meeting and Scientific Program at the Rosen Shingle Creek in Orlando, Fla., on July 10–12. In addition to outstanding dual education sessions for physicians and office managers, the society presented a $25,000.00 donation to the Rheumatology Research Foundation.

Florida Society of Rheumatology

Pictured: L-R: Starla Tanner, ACR; Guillermo J. Valenzuela, MD, Treasurer; Robert W. Levin, MD, President-elect; Pamela Freeman, MD, President; Dolores Korf, Rheumatology Research Foundation

ACR and ACR Affiliate Society Council Members Join Effort to Support Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries

The ACR and 25 members of the ACR Affiliate Society Council representing state and local rheumatology organizations from across the country are participating in national advocacy efforts to support the Increase Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2015 (H.R. 2461).

This legislation will have a profound effect on access to preventative bone density screening by creating a floor reimbursement rate under Medicare for the dual-energy x-ray absorptiometry (DXA) test administered in a doctor’s office. Read the letter and send a message of support to your lawmaker at the ACR’s Legislative Action Center.

Message from the Government Affairs Chair

Will HarveyAdvocates,

As we reported earlier this month, CMS has announced that for one year after Oct. 1, 2015, it will not deny claims on the basis of incorrect ICD-10 sub-codes, so long as the correct family of codes is used. They further stated that they will not penalize those reporting for quality programs if CMS has problems calculating quality scores because of the new codes. CMS will create an ICD-10 ombudsman to help providers with problems during implementation. Lastly, they will authorize advance payments if there is a claims processing problem of extended duration. Those of you following this issue will recall that the ACR has been fighting for these provisions for quite some time.

We’ve employed a large number of strategies, including op-eds (one of which was posted on The Hill just before the CMS news); letters to CMS and Congress, supporting AMA resolutions that mirrored our language; and most importantly, drafting legislation to force CMS to act.

On May 12, that legislation, the ICD-TEN Act (H.R. 2247), was introduced by Congresswoman Black of Tennessee. It calls for comprehensive testing with contingency plans if problems with processing are expected. It also calls for an 18-month implementation period where claims shall not be denied due to errors in sub-codes. In short, CMS has pledged to administratively enact, almost verbatim, our bill. They even went a step further with the quality program concessions. Of course, that was the whole point. This is another wonderful accomplishment with a few caveats.

This is not a full delay. The ACR has supported a full delay in the past, but sought this avenue of approach as a reasonable alternative to delay, with a greater chance of success. Also, this is not the 18 months we asked for. Your advocacy team will work to see how we can modify CMS’s decision or put in place other protections. Lastly, this affects only CMS (i.e., Medicare), not the private market. We continue to work on ways to get the same types of protections there if this coding system has to go forward.

In summary, ACR members have been vocal about their opposition to ICD-10, and the ACR has responded, playing a key role—not once, but twice now—in mitigating the impact of ICD-10 on our membership.

We used every tool in the toolbox. GAC and CORC strategy was fueled by RheumPAC to create productive meetings with key legislators, who wrote to CMS on our behalf and introduced our language to CMS and Congress. Our ACR staff and public relations team have been peppering Congress and the media about this issue. Our lobbyists have been making their way across the Hill, having meetings with key people. And once more we have overcome a massive, rich and vocal counter-advocacy campaign by those who stand to make the most money from the transition.

Although we are small, if we work hard and work together, we can continue to accomplish important things for our members and our patients. Thank you for being partners in our collective work to Advance Rheumatology!

Please do not forget to express your personal support for this rheumatology advocacy by donating to RheumPAC this year.

Will Harvey, MD, MSc
Chair, ACR Government Affairs Committee