RAC Challenges Unreasonable Codes and Policies
Since its installation last year, the Regional Advisory Council (RAC), a rheumatology advocacy limb of the ACR, caused insurance companies to change coding policies by challenging unfair practices.
"There have been several insurers who have questioned the use of modifier 25 with an office visit," RAC representative of the Western US region and chairman of the council Dr. Dan Fohrman reported.
"Others have questioned rheumatologists who use complex infusion codes to bill for Remicade infusions claiming they needed to be oncologists," he added. By educating insurers, these and similar issues have been clarified. As a result, the insurance company appropriately compensated the physician who alerted RAC of the incongruity.
Another insurer refused to pay for VFA and DXA tests that the physician ordered on the same day. RAC was able to influence the insurer to reverse the policy. Several insurers have also refused to pay for VFA under any circumstance. The RAC committee collaborated with ISCD and AACE to write a letter on behalf of the ACR objecting to this policy. Results of this issue are pending at this time.
Recently, regional advisors have presented to state societies in New York and Idaho about the committee and its goals and accomplishments thus far. Advisors will meet with New England, Montana, and others in the coming months.
To extend positive policy changes regarding treatments used in rheumatology, RAC is working with other specialties. Dr. Fohrman met with the President-Elect of the American Academy of Dermatology to discuss the organization's beginning advocacy efforts similar to those at ORA. RAC's goals include providing support for rheumatologists and state societies on issues of coding, reimbursement, denials, and policies, to provide expertise in reimbursement and coding, to provide two-way interaction between the ACR and its members, and to empower rheumatologists and state societies to advocate for themselves.