This week’s update includes information on joint advocacy strategy session on improving veterans’ healthcare and insurance updates pertinent to urology.
Veterans’ Healthcare: AUA Joins Veterans Health Council to Share Advocacy Priorities
On June 13, the AUA attended a partnership and advocacy meeting hosted by the Veterans Health Council of Vietnam Veterans of America. This meeting brought together more than 20 advocacy organizations to discuss opportunities to improve veterans’ healthcare. Several AUA advocacy partners were in attendance, including Prostate Health Education Network, RetireSafe, Caregiver Action Network, and ZERO. Through initial introductions of participants, common priorities included work on suicide prevention, post-traumatic stress disorder, women veterans, toxic exposures (i.e., Agent Orange), improving access to care through the VA system, PCORI reauthorization and access to infertility care for wounded warriors and veterans. Future meetings will focus further on these shared priorities and strategies to partner for improved access to healthcare, information and education for veterans, and support for families and caregivers.
“Surprise” Billing: AUA Meets with Main Senate Office Sponsor
The AUA recently met with staff in the office of Sen. Maggie Hassan (D-NH) who, along with Sens. Michael Bennet (D-CO), Bill Cassidy, MD (R-LA), Todd Young (R-IN), Lisa Murkowski (R-AK), and Tom Carper (D-DE), introduced the Stopping the Outrageous Practice (STOP) of Surprise Medical 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. Sen. Hassan is supportive of arbitration to resolve the medical bill issue. Arbitration provides an alternative for providers but may add regulatory complexity and cost. Her office is currently working with Sen. Lamar Alexander (R-TN), chairman of Senate Health, Education, Labor and Pensions (HELP) Committee, on the arbitration approach.
As mentioned in last week’s Policy Blog, the AUA cosigned an Alliance of Specialty Medicine letter sent to the Senate HELP Committee providing feedback on the surprise billing issue, which is part of a larger draft healthcare bill entitled the Lower Healthcare Cost Act of 2019.
Prior Authorization: Bill Introduced and Grassroots Alert
Last week, the AUA, together with the Regulatory Relief Coalition, announced support for H.R. 3107, the Improving Seniors’ Timely Access to Care Act of 2019. As previously reported, this bill would protect patients from unreasonable Medicare Advantage plan requirements that needlessly delay or deny access to medically necessary care. The AUA has launched a grassroots campaign urging lawmakers to cosponsor this bill. Please consider contacting your Representative and asking your physician colleagues to do the same.
AUAPAC Update: Rep. Robin Kelly (D-IL-2)
On June 12, AUAPAC delivered its fourth check for the election cycle to Rep. Robin Kelly. She is a member of the House Energy and Commerce Committee and chair of the Congressional Black Caucus Health Braintrust. She was the congressional speaker at this year’s Annual Urology Advocacy Summit Congressional Reception. The AUA will continue to work with her office and the Congressional Black Caucus going forward, particularly focusing on health care disparities in prostate cancer and other urologic conditions. Learn more at www.myAUAPAC.org.
Insurance Updates: Week of June 17, 2019
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes information from several insurance companies. United Healthcare (UHC) Community Plan has revised its Prolia/Xgeva pharmacy policy. Centene has revised its Xtandi policy, including that it must be prescribed by an oncologist or urologist. First Coast Service options has a new supplemental article for Sacral Neuromodulation. Blue Cross Blue Shield of South Carolina has revised its Percutaneous Tibial Nerve Stimulation medical policy. Quartz Unity Health Plan has revised its Prostatic Urethral Lift medical policy criteria. Blue Cross Blue Shield of Florida has revised its Abiraterone Acetate (Yonsa®/Zytiga®) medical policy, and Blue Cross Blue Shield North Carolina (BCBSNC) has a new medical policy for Erectile Dysfunction. In addition, Blue Cross Blue Shield Tennessee has revised its Jevtana medical policy. Read more here.
Practice Management: Evaluation & Management Auditing Service
Would you like to improve the financial health of your practice? If so, the AUA’s Evaluation & Management (E&M) Audit Service is an essential option for your team. Designed for E&M services and minor procedures only, the E&M Audit Service provides a mechanism for educating providers on documentation guidelines, ensuring all services are supported, and all appropriate revenue is captured. There are multiple benefits to participating in this program:
- Our audit service is urology-specific and is being performed by certified coders who are experts in the field.
- No medical records are outsourced to a third party. All auditing is done at the AUA.
- The service offers your practice an opportunity to identify reimbursement deficiencies and increase revenue by spotting under-coding and unbilled services.
Slots for this program are limited and will be filled based on submission date and availability. Visit the AUA’s Evaluation & Management Service page to learn more about using this service for your practice.