Blogs

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This week's update includes information on our joint Congressional Briefing on U.S. Preventive Services Task Force (USPSTF) reform with Men’s Health Network and ZERO - The End of Prostate Cancer, medical liability reform, and a request that you join a Thunderclap campaign  for Men’s Health Month by registering for the campaign by May 31. U.S. Preventive Services Task Force (USPSTF) Reform: Hill Briefing and Congressional Outreach On May 17, the AUA participated in an educational briefing on Capitol Hill with the Men’s Health Network, ZERO - The End of Prostate Cancer, and the Vietnam Veterans of America. The briefing was designed to educate Hill staff ...
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With the volume of urologic coverage policies that flood the AUA every day, it is imperative that each policy is reviewed to ensure that our physician membership is receiving the proper reimbursement for the services that are rendered to their patients. Here are the latest insurance issues relevant to urology. United Healthcare:  Site of Service for Certain Outpatient Surgical Procedures: New CPT Codes Requiring Prior Authorization Prior authorization is required for procedures if performed in an outpatient hospital setting. CPT codes for urology services: 50590: Lithotripsy, extracorporeal shock wave 52000 : Cystourethroscopy 52005: Cystourethroscopy, ...
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This call focused on this month’s updates: IPPS and LTCH PPS proposed rule updates, Wage Index Time Table updates, and with other proposal item updates. FY 2018 Inpatient Prospective Payment System/ Long-Term Care Hospital PPS Proposed Rule CMS is proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these proposed changes would implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving ...
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Blue Cross and Blue Shield of North Carolina Blue Medicare Pre-Payment Audit Begins in May  Blue Cross and Blue Shield of North Carolina contracted a vendor to audit Blue Medicare claims, prior to being paid. The audit begins May 2017 and will be an ongoing effort. All Medicare Advantage claims will be part of the review. To start, the focus will be on: Add-on code billing errors Bundled services and supplies Duplicate claims Established patients billed as new patients Inconsistent places of service Missing professional or technical services modifiers Global surgical periods While the audit is being conducted, claims ...
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The proposed merger between Anthem and Cigna has been terminated and is seen as a victory to some in the healthcare industry. The termination of this agreement will allow competition in the health insurance industry. Insurance networks are narrow enough and by condensing larger payers it would only give patients fewer options to choose benefits that are right for them. In October 2015, the AUA signed onto a letter issued by various national organizations supporting the final National Association of Insurance Commissioners (NAIC) Managed Care Plan Network Adequacy Model Act. This act would establish a clear set of standards necessary to ensure network adequacy. ...
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The AUA Board of Directors recently approved three related but separate white papers on enhancing surgical outcomes.  To limit the scope of this broad subject, the topic will be divided into the following papers: Preoperative strategies to enhance surgical outcomes Intraoperative strategies to enhance surgical outcomes Postoperative strategies to enhance surgical outcomes The Quality Improvement and Patient Safety (QIPS) Committee is charged with developing white papers and recently developed a scoring worksheet for prioritizing topics for white paper development. Criteria for a topic on a quality/patient safety issue include clinical importance, ...
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Government and Regulatory Update Dr. Mark Fallick of Delaware Valley Urology delivered important messages on advocacy issues that are affecting urology practice managers. Dr. Fallick discussed topics including SGR repeal, urotrauma, fertility coverage for wounded servicemen/women, USPSTF reform, urology workforce shortage and medical liability reform. Coding and reimbursement topics were also discussed, including the importance of physician participation in the RUC survey. Physician Compensation and your Organizational Goals Dr. Arthur Tarantino, Lead Physician of the Urology POD, Hartford Healthcare Medical Group in Connecticut is ...
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Seven Years after the ACA Passage- Top Ten Lessons Learned Max Reiboldt, President and Chief Executive Officer at Coker Group provided practical examples of urology-specific initiatives to assist the daily operations of conference attendees. The presentation also focused on the changing industry reimbursement requirements (from MACRA to bundled payments). Max presented strategic alignment and integration issues in light of new industry dynamics. Moving from Volume to Value in Top’s Healthcare Dr. Neil Baum, Associate Clinical Professor of Urology at Tulane Medical School and Louisiana State University Medical School, lead a presentation ...
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Meeting Highlights: 2017 SUFU

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SUFU TAKE HOME MESSAGES FOR GURS Doreen E. Chung MD, FRCSC and  Jessica DeLong MD April 2017 The Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) 14 th annual winter meeting was held in the desert city of Scottsdale Arizona at the Hyatt Regency Scottsdale at Gainey Ranch. Kathleen Kobashi, MD, and Jennnifer Anger, MD, the program chairs, put together an outstanding comprehensive dynamic program complemented by a vibrant basic science program chaired by Adam Klausner, MD,  and Lori Birder, PhD. One recurrent theme was the the utility of urodynamics (UDS) in guiding treatment decisions and for predicting ...
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This week’s update includes an update on the AUA’s comment letter on the USPSTF draft recommendation on screening for prostate cancer, our coalition advocacy on regulatory reform, IPAB repeal and increased research funding. U.S. Preventive Services Task Force (USPSTF): AUA and Urologic Community Respond to Draft Recommendation On May 8, the AUA was joined by eight Sections, 10 subspecialty societies, and two patient advocacy groups, in responding to the USPSTF draft recommendation on screening for prostate cancer. The AUA letter collectively represented organizations representing more than 15,000 urologists, more than 200 physician assistants in urology, ...
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Today, the AUA was joined by eight Sections, 10 subspecialty societies, and two patient advocacy groups in responding to the U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement on Screening for Prostate Cancer. The AUA letter collectively represented organizations representing more than 15,000 urologists, more than 200 physician assistants in urology, more than 2,000   urologic nurses and associates, and hundreds of thousands of individuals impacted by prostate cancer in the United States. A copy of the letter is available here . While we applaud the USPSTF for recognizing the need for an individualized approach to prostate-specific ...
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MIPS Participation Status Letters The Centers for Medicare & Medicaid Services (CMS) is sending a communication to all clinicians to inform them if they must participate in the Merit-based Incentive Payment System (MIPS).  The letters, generated by the Medicare Administrative Contractors (MACs), will be sent based on Taxpayer Identification Numbers (TINs).  If a provider is associated with multiple TINs, he/she should check with each TIN to verify the MIPS status for each. CMS has provided a sample of the communication, which includes a letter with two attachments, so that clinicians know what to expect to see in the document.  The letter itself ...
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The Food and Drug Administration (FDA) announced that Organic Herbal Supply, Inc . is voluntarily recalling many of its products promoted for sexual enhancement after an FDA analysis found the supplements contained undeclared ingredients.  The products and the undeclared ingredients are: BigNHard (Tadafil) Cummor (Tadafil) Enhancerol (Tadafil) LabidaMax (Flibanserin) Monkey Business (Tadafil) Rectalis (Tadafil) Tornado (Tadafil) Uproar (Tadafil) Xrect (Tadafil) Zdaily (Tadafil) Zrect (Tadafil) Zrect for Women (Flibanserin)   Tadafil is an FDA-approved pharmaceutical ingredient used to treat erectile dysfunction, and ...
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The AUA Coding and Reimbursement Committee (CRC) was successful in adding two diagnosis codes for hCG National Coverage Policy N190.27 that covers testicular and other cancers.  An AUA member pointed out that the policy did not include diagnosis codes that would allow payment of CPT code 84702 Gonadotropin, chorionic (hCG) quantitative for  malignant neoplasm of the testis and/or personal history of malignant neoplasm of testis. A hCG level before surgical removal of a presumed testicular cancer, such as a patient with abnormal urologic imaging or a neoplasm of an unspecified behavior of the testicle, is standard of care. A diagnosis of malignant neoplasm ...
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CPT Code 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistant when performed is a code used for surgical treatment for prostate cancer. The procedure is performed to remove the prostate using laparoscopic or robotic devices. There are several procedures inherent to 55866 and these procedures should not be reported separately from the laparoscopic robotic prostatectomy. Since several questions have come in on the Coding Hotline, we’d like to provide further guidance. A cystoplasty or cystourethroplasty is the reconstruction of the bladder neck and subsequent reconnection of the urethra after prostate ...
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There has been some confusion by members for reporting a voiding pressure study using the penile cuff. At this time, there is no CPT code available to report a pressure study using the penile cuff. As stated in our previous article in the Brief , the Coding and Reimbursement Committee (CRC) reviewed the reporting of the penile cuff for a voiding pressure study in male patients.   The penile cuff is a non-invasive diagnostic test for male urinary disorders, also known as lower urinary tract symptoms (LUTS). The test uses an external penile cuff (resembling a blood pressure cuff) to measure bladder pressure while also calculating your flow rate. The ...
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This month’s Centers for Medicare & Medicaid Services (CMS) Physicians, Nurses & Allied Health Professionals Open Door Forum (ODF) focused on these issues: Open Payments, CERT A/B MAC Outreach and HHS Risk Adjustment Data Validation Program (HHS-RADV). Open Payments-Review and Dispute Annual Open Payments data is now available for public view, on the CMS website www.cms.gov/openpayments , through May 15, 2017 . CMS has released several Open Payments reference guides on their website: Review and Dispute Timing and Data Publication Quick Reference Guide Physician and Teaching Hospitals: 2016 Program Year Registration Tutorial Open ...
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This week’s update includes information on the U.S. Preventive Services Task Force (USPSTF) recommendations on PSA-based screening for prostate cancer, medical liability reform, insurance updates, and our We Work For Health coalition meeting with Senator Chris Van Hollen’s office. Global Surgery: Centers for Medicare & Medicaid Services (CMS) Discusses Data Collection Requirements On April 25, the AUA participated in a conference call on “Required Data Reporting for Post-Operative Care”. The call reviewed the data collection requirements that go into effect July 1, as well as the CMS resources available for reporting. The call also allowed the physician ...
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On May 11, as part of the 2017 AUA Practice Management Conference in Boston, Edna Maldonado, certified professional coder and AHIMA ICD-10-Trainer ,will deliver her presentation “Strategies for Denials- Maximizing your Revenue Stream” to our conference attendees.  Edna Maldonado is the Coding Coordinator for the Practice Management Department and supervises our Coding hotline. Prior to the AUA, Edna was in a urology practice for 20 years. She is a wealth of knowledge when it comes to coding and reimbursement. During her presentation, Edna will discuss strategies for navigating insurance claim denials. “We will cover multiple strategies for managing the ...
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On May 12, as part of the 2017 AUA Practice Management Conference in Boston, This week’s highlight will highlight Dr. Deepak Kapoor. During his presentation, “MACRA and How It Affects You,” Dr. Kapoor will discuss the progression of changes in health care legislation.    Dr. Deepak Kapoor is the chairman and CEO of Integrated Medical Professionals, PLLC. In addition to his duties with IMP, Dr. Kapoor is a Clinical Associate Professor of Urology, at the Icahn School of Medicine at Mount Sinai He has over 20 years of clinical and business expertise. His detailed presentation will explain the impactthat MACRA (including MIPS/APMS) is having on urology practices.  ...
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