Rheumatology Practice Management December 2017 Vol 5 No 6

Building an Effective Rheumatology Compliance Plan

Kansas City, MO—At the 12th annual National Organization of Rheumatology Managers conference, held September 14-16, 2017, practice managers, physician managers, and other healthcare administrators gathered to network with their peers and attend educational sessions on the future of rheumatology management in the age of value-driven healthcare.

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Reflections on a Successful Year

Happy holidays and warmest wishes to you and your staff from the National Organization of Rheumatology Managers (NORM)!

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ACR Responds to 2019 Benefit and Payment Parameters Proposed Rule

In a press release from November 28, 2017, the American College of Rheumatology (ACR) is urging the Centers for Medicare & Medicaid Services (CMS) to reconsider proposals reducing health exchange insurance coverage, affordability, and patient choice.

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Managing Self-Pay Accounts Receivable

In contrast to selling or outsourcing self-pay accounts receivable, lending institutions may provide 0% or low-interest rate loans to patients to cover their estimated responsibility. The institution has to have an adequate process and knowledge base to create estimates based on residual responsibility after the insurance payment.

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“Nurse Visits” and Current Procedural Terminology Code 99211

We frequently receive questions regarding the infamous “nurse visit,” and what documentation Medicare or other payers expect to see when billing the Current Procedural Terminology code 99211. So, what are the exact medical documentations that would support billing the evaluation and management (E&M) code 99211 alone or with other billable services?

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The following clinical trials represent a selection of key studies that are currently recruiting patients with juvenile idiopathic arthritis (JIA) for inclusion in investigations of new therapies and new regimens of existing treatments for individuals with the disease.

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Medical Groups Applaud Congressional Leaders for Bipartisan Agreement to Repeal Medicare Therapy Caps

Under the new proposed framework, the Medicare Part B therapy caps would be repealed beginning January 1, 2018. The new bipartisan agreement will continue the manual medical review process and the requirement of an appropriate modifier for claims submitted above the new threshold if procedures are considered medically necessary.

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Efficacy and Safety of Switching from Adalimumab to Sarilumab

This analysis evaluated the sustainability of clinical responses and improvements in physical function achieved on MONARCH at week 24 with continued sarilumab monotherapy, and assessed disease activity, physical function, and safety in adult patients switching from adalimumab to sarilumab.

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Sustained Response in TARGET Study of Sarilumab + csDMARDs versus Placebo in RA Patients with Inadequate Response to TNF Inhibitors

The phase 3 TARGET study demonstrated that sarilumab (150 or 200 mg subcutaneously every 2 weeks [q2w]) plus conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) achieved clinical responses in terms of rheumatoid arthritis (RA) signs and symptoms and physical function compared with placebo in adults with active, moderate-to-severe RA who were intolerant of, or showed inadequate response to, tumor necrosis factor (TNF) inhibitors.

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A previous study reported that highly sensitive cardiac troponin I (cTnI; >1.5 pg/mL) was an independent predictor of occult coronary plaque burden and composition on coronary computed tomography angiography (CTA) in patients with established rheumatoid arthritis (RA).

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