This week’s update includes information on surprise billing legislation currently under review by the Legislative Affairs Committee and our participation in fly ins hosted by One Voice Against Cancer (OVAC) and RESOLVE: The National Infertility Association and the American Society for Reproductive Medicine. We also share news about the Alliance of Specialty Medicine and AUA’s future meeting with the Centers for Medicare & Medicaid Services to address prior authorization or step therapy protocols that cause delays in treating patients.
Surprise Billing: AUA Reviews Legislation Introduced in the Senate
On May 16, Sen. Bill Cassidy, MD (R-LA), along with Sens. Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK), and Tom Carper (D-DE), introduced the Stopping the Outrageous Practice (STOP) of Surprise Bills Act of 2019 aimed at addressing the issue of surprise medical billing that usually occurs after a patient receives emergency care from a physician or hospital that is not part of their insurance network. If passed, the STOP Surprise Bills Act would require that providers automatically be paid the difference between a patient’s in-network cost-sharing amount and the median in-network rate for the service in question, but health providers and insurance plans would have the opportunity to appeal the payment amount through an arbitration process. The Legislative Affairs Committee currently is reviewing the bill.
While the legislation could greatly reduce the chance of a patient getting charged out-of-network rates for emergency room services when neither the patient nor the provider is aware of out-of-network status, it could also increase the regulatory burden placed on physicians by having them go through arbitration to adjust reimbursement rates that are too low for the services rendered.
Congressional Outreach: AUA Meets with Nearly 70 percent of Freshman Offices
The AUA wrapped up its initial outreach efforts to freshman offices with an additional 11 meetings last week. Between May 14 – 16, the AUA met with staff in the offices of Reps. Jim Baird (R-IN-4), Abby Finkenauer (D-IA-1), Max Rose (D-NY-11), Antonio Delgado (D-NY-19), Kendra Horn (D-OK-5), John Rose (R-TN-6), Lauren Underwood (D-IL-11), Steve Watkins (R-KS-2), Chip Roy (R-TX-21), Dan Meuser (R-PA-9), and Kim Schrier, MD (D-WA-8).
Congresswoman Finkenauer expressed interested in workforce issues as she is soon to introduce the Keep Physicians Serving Act, which would improve the way the physician work and practice expense geographic practice cost indexes (GPCIs) are calculated. Ms. Finkenauer expressed her concern that these indices are calculated using inaccurate data that underestimates the cost of practicing in non-urban areas. As the AUA continues to have conversations around rural and underserved health communities, we are looking at this legislation as possible option to support. Rep. Underwood, who is a registered nurse, is supportive of a number of the AUA's legislative priorities. She along with Sen. Dick Durbin (D-IL) and Rep. Bill Foster (D-IL-11) introduced the American Cures Act (H.R. 2401/S. 1250) which would create a mandatory fund to provide steady, predictable funding for breakthrough research at America’s top research agencies, allowing the United States to remain a leader in development and discovery for decades to come.
These were part of a series of meetings that the AUA was holding with freshman offices to educate them on the association and the key role urology plays in healthcare. The AUA was able to meet with roughly 70 percent of all freshman offices within the first five months of the 116th Congress. We will continue to build relationships with these offices by educating them educating them on specific issues of concern to urology as they arise.
Patient Advocacy Outreach: AUA Participates in Advocacy Events Supporting Research Funding Allocations, Women’s Health Needs, and Access to Infertility Treatment
On May 14, the AUA joined 24 organizations who participated in One Voice Against Cancer’s (OVAC) annual fly-in. Advocates met with more than 140 legislative offices and urged lawmakers continue strong support for cancer research and registries. Specific asks included raising the budget caps; increasing National Institute of Health funding to $41.6 billion for Fiscal Year (FY) 2020; increasing funding for the National Cancer Institute (NCI) to $6.5 billion for FY 2020; and providing $555 million in funding to the Center for Disease Control and Prevention for cancer programs, including $70 million for cancer registries. The AUA participated in meetings with Senator Cardin (D-MD), Senator Van Hollen (D-MD), Representative Cummings (D-MD-07) and Representative Raskin (D-MD-08). As background, OVAC is a coalition of public interest groups that represent cancer researchers, physicians, nurses, patients, survivors, their families, and caregivers.
On May 14, the AUA attended the Bolder Women’s Health Coalition’s Annual stakeholder meeting hosted by the National Association of Nurse Practitioners in Women’s Health. The meeting created an opportunity for coalition partners to discuss the Bolder Women’s Health Agenda that focuses on four key principles: clinical education, policy, public education, and research. Several of AUA’s advocacy partners were in attendance, including American College of Obstetricians and Gynecologists, Caregiver Action Network, HealthyWomen, National Multiple Sclerosis Society, and Society of Women’s Health Research. Meeting attendees shared resources related to each of the key principles and a resource toolkit will be made available to coalition members in late 2019. As background, the Bolder Women’s Health Coalition aims to catalyze a new awareness of the health and wellness needs of older women and break down stereotypes that lead to further illness, social isolation, and diminished quality of life. The coalition comprises more than 25 advocacy organizations who coordinate advocacy and education efforts, share resources, and formulate a Bolder Women’s Health Agenda.
On May 16, the AUA participated in an advocacy fly-in co-hosted by RESOLVE: The National Infertility Association and the American Society for Reproductive Medicine. Advocates in attendance included more than 100 representatives from all facets of the infertility field including patients, physicians and nurses. Representative Wasserman Schultz (D-FL-23) provided opening remarks and shared her journey with in vitro fertilization that allowed her to conceive a set of twins. During meetings with lawmakers, advocates discussed the following pieces of legislation: Access to Infertility Treatment and Care Act (S.1461 H.R. not yet introduced), Women Veterans and Families Health Services Act (S. 319 H.R. 955), Every Child Deserves a Family Act (legislation not yet a bill), PCOS Awareness Month Resolution, and an increase in funding for the National Institute of Child Health and Human Development to $1.6 billion in FY 2020. The AUA met with the offices of Representatives Ruppersberger (D-MD-02), Cummings (D-MD-07), and Harris (R-MD-01) and Senators Van Hollen (D-MD) and Cardin (D-MD). Additional information about the legislation discussed will be provided in the coming weeks.
Step Therapy: CMS Responds to Alliance Letter on Medicare Advantage
The Centers for Medicare & Medicaid Services (CMS) has invited the Alliance of Specialty Medicine, of which the AUA belongs, to meet with them to discuss examples from specialists of prior authorization or step therapy protocols that caused delays in treating patients. The invitation follows a January 2019 meeting where the Alliance suggested changes to Medicare Advantage Part B step therapy and prior authorization policies.
In addition to the invitation, Mr. Kouzoukas outlined what CMS has been doing in this arena to reduce burdens on physicians and improve quality programs. This included participation in the DaVinci project, a private sector initiative led by the standards development organization, Health Level 7. CMS is working with other payers, Electronic Health Record vendors, provider and the Office of the National Coordinator for Health Information Technology to help find ways to reduce burdens related to prior authorization and documentation requirements.
Insurance Updates: Week of May 20, 2019
Each week, the AUA publishes weekly updates on the lasted insurance issues pertaining to urology. This week’s update includes important information on United Healthcare’s Discarded Drugs and Biologicals medical policy. You also may read the new requirements for Anthem Blue Cross’s Timely Filling for correcting claims. Read more here.
Practice Management: 2019 Practice Management Conference Recording, AUA Coding Seminar
Establishing effective practice operations, increasing physician compensation, and maximizing practice revenue streams were just a few of the educational presentations at this year’s Practice Management Conference (PMC). The AUA offers the entire educational presentation from the PMC including full-length recordings of each presentation, lecture, and breakout session. Previews for each recording will be featured weekly on the AUA Practice Managers’ Network online community. The 2019 PMC Recording is available for the low cost of $299 and may be purchased here.
Register today for the AUA’s Las Vegas Coding Seminar, taking place this year on July 19-20. This event is widely-praised by its attendees, with one suggesting that they “highly recommend that physicians, managers, coders and billers of any level should attend.” This year’s seminar will feature experts in the field of urology, such as Dr. Jay Motola, Sean M. Weiss, Max Reiboldt, and many more. Our presenters will provide updates on coding changes, discussions of common coding questions and payment denials gathered from the AUA Coding Hotline. The seminar will offer practical exercises to hone the skills of anyone in the practice who is involved with CPT, HCPCS, or ICD coding. The seminar also will feature coding workshops to educate attendees on coding basics and discuss surgical coding challenges, as well as an auditing workshop, which will show the attendees how to face the challenges of Evaluation and Management documentation head on.
Visit our website to view the seminar schedule for each day and register for the AUA Coding Seminar.