RheumWATCH Archives

”RheumWatch

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

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Avoid PQRS Payment Penalty - Register for the ACR’s New PQRS Reporting Registry

Register Now for the ACR’s New PQRS Reporting Registry!

Gone are the PQRS incentive payments of previous years. Starting this year, CMS will assess a penalty for providers who do not meet PQRS reporting requirements. Are you looking for an easy-to-use, web-based tool to report PQRS and avoid the penalty? The ACR is here to help you! Sign up today for the ACR’s new and improved Rheumatology Clinical Registry and start reporting now.

Based on feedback we received from ACR/ARHP members, we have made changes to the Rheumatology Clinical Registry (RCR) for PQRS reporting. We are excited to share this new reporting platform with you! You will still be able to report via registry for PQRS 2015, and the data entry process will be simplified for those who choose to report.

Register and start reporting today to avoid the 2017 negative payment adjustment!

RCR Registration

PQRS Reporting Fee: $249/provider

Reporting Deadline: Jan. 31, 2016

The RCR is designed for individual provider reporting. If you registered your practice tax ID number for the Group Practice Reporting Option (GPRO), you will need to select an alternative reporting method.

Reporting Instructions

  • RA Measures Group - Report all 8 measures within the RA Measures Group. Measures with a 0% overall performance rate will not count for PQRS reporting.
  • Patient Sample Criteria - The RA Measures Group is to be reported for patients ages 18 years and older with a diagnosis of RA accompanied by a specific patient encounter.
  • Reporting Period - 12-month reporting period: January 1–December 31, 2015.
  • 20 Patient Sample Method - At least 20 unique patients meeting sample criteria for the measures group. At least 11 unique Medicare Part B FFS patient encounters must be included in the sample.

For more information about PQRS reporting through the Rheumatology Clinical Registry (RCR), please contact Maryam Gueye at mgueye@rheumatology.org or 404-633-3777.

ACR Releases Two New Publications: Guidelines for Treatment of PMR and Classification Criteria for Gout

The ACR has released two new publications—recommendations aimed at improving the treatment of patients with polymyalgia rheumatica (PMR), and new classification criteria for gout.

Recommendations for Management of PMR
The new PMR guidelines were developed as part of a collaborative project with the European League Against Rheumatism. They are the first international recommendations for the screening, treatment, and management of PMR. These recommendations are based on current evidence and thinking in the field of PMR management with a particular emphasis on patients' perspectives, and they also inform primary, secondary, and tertiary care physicians about international consensus on the management of PMR.

Introduction of Robust Gout Criteria
The new gout classification criteria were also developed as part of a jointly supported project with EULAR. They represent an international collaborative effort to define the important disease features that are useful in classifying patient symptoms caused by gout. Ultimately, the classification criteria provide a structure that will facilitate a better understanding of the disease and its course and expedite development of new therapies and clinical trials.

Read the press release to learn more about these new publications.

State Advocacy Efforts - ACR Florida Member Advocates for Patients’ Access to Preferred Medications

Dr. Robert W. Levin, a practicing rheumatologist in Florida and President-Elect of the Florida Society of Rheumatology, has been an involved advocate against the negative effects of step therapy, also known as “fail first.” This harmful insurer practice affects thousands of rheumatic disease patients across the county.

He currently has a long list of patients waiting to get their medicine approved through insurance companies. The longer patients wait for prescribed therapies, the worse their conditions can become.

Recently, Dr. Levin was featured in a television interview discussing the everyday reality experienced by patients due to this process.

Learn more about step therapy in the WTSP News 10 interview with Dr. Levin.

To join ACR advocate efforts related to step therapy and other critical issues, join our Key Contacts program.

Message from the Government Affairs Chair

Will Harvey Advocates,
The ACR is tracking two new issues related to ICD-10. The first is that of private payers and some Medicaid payers refusing to grant the same leniency around the ICD-10 transition that CMS has announced. Organizations in the Coalition for ICD-10, which has been speaking out against any sort of delay, including the ACR’s previous bill H.R. 2247, have wanted to use this specificity for years now and it is not completely surprising that many members of that coalition, or close affiliates, have announced they will insist on specificity.

We have limited ability to influence the behavior of hundreds of payers at this point, with two weeks to go. Because most of us lack the capability of knowing who the payer is when we select codes for billing and whether that particular payer will show leniency or not, we strongly urge rheumatologists to code to as much specificity as possible. The ACR has created a “superbill” and other resources, including an on-demand webinar, that you can leverage to help. As always, please reach out to our practice management team before or after Oct. 1. You can write to practice@rheumatology.org or call 404-633-3777.

The second issue involves four states that will be cross-walking back to ICD-9 to determine claims for their Medicaid programs. This news underscores our longstanding opposition to this implementation. This practice is of questionable wisdom, and we are trying to estimate what impact it will have specific to rheumatology codes. Our preliminary analysis is that this internal practice by states’ Medicaid programs will likely not cause many denials because most ICD-10 codes can be mapped back to a less specific ICD-9 code. Beyond rheumatology it is unclear what the true impact is and we are studying that as well.

As stated above, we strongly believe payers will use the specificity in ICD-10 to deny more claims. If some are cross-walking them back to ICD-9, which has less specificity, then it limits their ability to deny based on specificity. That could be a good thing. There could be claims denials; on a global scale, there certainly are 10-codes without 9-codes to match. But cross-walking from a 10 to a 9 is much easier than the other way around. Goose and gander discussions aside, we will plan to evaluate commonly used codes in rheumatology and given the fact that there are 20 business days until Oct. 1, we will use our resources as appropriate to guide members on the likely impact in these states and how to mitigate it.

Again, please contact practice@rheumatology.org or call 404-633-3777 for any assistance you may need with the ICD-10 transition. The ACR is here for you as this significant change moves forward and will continue to watch out for your practice.

Will Harvey, MD, MSc
Chair, Government Affairs Committee