This week’s update includes information on the AUA’s joint advocacy with several organizations on Capitol Hill on to support PCORI Reauthorization, spinal cord injury awareness, and cancer prevention. We also update you on the BCG shortage and the introduction of the USPSTF Transparency and Accountability Act of 2019.
Advocacy on Capitol Hill: PCORI Reauthorization, Spinal Cord Injury Awareness, and Cancer Prevention among Top Priorities
On June 24-25, the AUA participated in United Spinal Association’s 8th Annual Roll on Capitol Hill event. More than 115 spinal cord injury/disorder advocates from 37 states participated in 215 meetings with Congressional offices on Capitol Hill during the fly-in. The AUA met with staff in the offices of Sens. Jim Inhofe (R-OK), Mike Enzi (R-WY), James Lankford (R-OK) and John Thune (R-SD), and Representatives Glenn Grothman (R-WI-6), Marcy Kaptur (D-OH-9), and Kendra Horn (D-OK-5). Conversations with congressional staff focused on autonomous vehicles (AV), the Air Carrier Access Amendment Act and the Protecting Access to Wheelchairs Act (HR 2293). Additionally, United Spinal hosted a Congressional Reception, where Congressman Brian Mast (R-FL-18) received the 2019 James J. Peter Distinguished Veterans Legislator Award. Rep. Mast spoke with advocates and encouraged a continuation of advocacy efforts for those with a spinal cord injury or disorder (SCI/D).
On June 26, the AUA attended a briefing hosted by Research!America entitled, “Improvements to Rural Health Care Through Patient-Centered Research.” The briefing aimed to explore advances in patient-centered research to improve delivery of care in rural areas. Senator Chris Van Hollen (D-MD) provided opening remarks that addressed the need to continue working in a bipartisan effort towards reauthorization for the Patient Centered Outcomes Research Institute (PCORI) prior to the funding expiration date of September 30. It was conveyed that PCORI research is unique in that it centralizes around the patient voice and promotes physicians and patients working together to improve patient care. Additional presentations took place by representatives from PCORI, National Rural Health Association, and American Heart Association. Key messages included how patient-centered, community-based programs can lower the risk of disease and improve overall access to healthcare, the need for strategies to address physician workforce shortages in rural health communities, and proposed strategies to overcome obstacles associated with health disparities in rural populations. The AUA will continue to keep you apprised of when the Senate version of the bipartisan PCORI Reauthorization legislation is introduced.
The AUA joined a diverse group of advocacy organizations who actively advocate for cancer prevention, screening, and treatment at a briefing titled, “Let’s End HPV-related Cancers.” The American Association for Cancer Research (AACR) Moffitt Cancer Center, and Biden Cancer Initiative in partnership with the American Cancer Society Cancer Action Network (ACS CAN), American Society of Clinical Oncology (ASCO), Association of American Cancer Institutes (AACI), Prevent Cancer Foundation, St. Jude Children’s Research Hospital, and the Union for International Cancer Control (UICC) hosted the event. Congresswoman Kathy Castor (D-FL-14) provided opening remarks to the group and discussed the importance of the human papillomavirus (HPV) vaccination. Due to advancements in this vaccine, as well as other treatments and screening, it is ultimately possible to eliminate cervical cancer and other HPV-related cancers (which include penile, anus and throat cancers in men). This message was woven throughout each presentation. Dr. John Schiller of the National Cancer Institute (NCI) added the importance of Congress continuing to provide the National Institutes of Health (NIH) funding, as the HPV vaccination that has saved so many lives was a product of NIH funding. More than 33,000 HPV-related cancers are diagnosed each year, which has lead the World Health Organization (WHO) to release a call to action for the global elimination of cervical and other preventable cancers. The AUA will continue to follow developments and share with you information from the NCI and Centers for Disease Control & Prevention (CDC) regarding HPV-related cancers.
USPSTF Reform: Bill Reintroduced in the House
On June 27, Reps. Bobby Rush (D-IL-1), Phil Roe, MD (R-TN-1), Judy Chu (D-CA-27), and Neal Dunn, MD (R-FL-2) reintroduced the USPSTF Transparency and Accountability Act (H.R. 3534). This important bipartisan bill calls for reforms to the USPSTF and the process by which the group makes formal recommendations regarding preventive care services for Americans. Specifically, the bill calls for expanded research plans that account for subpopulations; requires the USPSTF to convene a stakeholders board to provide feedback on activity and to recommend topics and evidence for review; and mandates a 45-day minimum comment period for public comments. Additionally, the USPSTF would be required to respond to specific public comments on research plans and recommendations.
You can read the AUA’s press release on the reintroduction, with quotes from Public Policy Council Chair Dr. Chris Gonzalez, by clicking here. The joint press release from the four sponsors can be found here. The AUA will be running a grassroots campaign to support the bill in the coming weeks, and we will ask that you help us by sharing the campaign with your colleagues.
Sen. Marsha Blackburn (R-TN) is working to introduce a Senate companion bill sometime after the July 4th holiday. We will keep you updated as that issue continues to progress.
Coding and Reimbursement Committee BCG Update: New BCG HCPCS Code Effective July 1, 2019 and Important Considerations before Splitting Vials
The Centers for Medicare & Medicaid Services (CMS) recently released a new Healthcare Common Procedure Coding System (HCPCS) J9030 BCG live intravesical, 1 mg. to replace J9031 BCG (intravesical) per instillation. This change was a result of the BCG shortage conversations and CMS and would allow more accurate coding if less than a whole vial of BCG is given to a patient. However, there are other concerns prior to splitting a vial for instillation for more than one patient. Dr. Rubenstein outlines important considerations for practices in this blog post. Read more here.
BCG Shortage Update: AUA meets with New York Senator
On June 28, the AUA met with staff in Sen. Charles Schumer’s (D-NY) office regarding BCG coding and billing. In light of the current BCG shortage, groups such as the AUA and others have proposed split-vial dosing (vs. discarding unused solution) as an option to maximize patient access to this important therapy. We encouraged Sen. Schumer’s office to have the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MAC) aligned on the reimbursement for less than a single vial of BCG. CMS does accept reporting of the amount less than the total vial if the requested amount of reimbursement also is listed on the claim. However, some of the MACs have said they will not reimburse or have stayed mute in response to our question. We do not know how MACs will reimburse for the new J code for BCG that allows them to report the amount given to a patient by recording the number of milligrams of solution given. For more information refer to the information above article or if you have questions, please contact PaymentPolicy@AUAnet.org.
AUAPAC Update: Rep. David McKinley (R-WV-1), Rep. Dutch Ruppersberger (D-MD-2), Sen. Marsha Blackburn (R-TN)
On June 26 and 27, AUAPAC delivered checks to Reps. David McKinley (R-WV), C.A. Dutch Ruppersberger (D-MD) and Sen. Marsha Blackburn (R-TN). Rep. McKinley is a member of the House Energy & Commerce Committee, has served on a hospital board in his home state of West Virginia, enthusiastically supports funding for the National Institutes of Health, and has expressed an interest in addressing the physician workforce shortage in rural America. Rep. Ruppersberger represents the area where the AUA is headquartered in Linthicum, MD, and sits on the House Appropriations Subcommittee on Defense, which oversees the Congressionally Directed Medical Research Program (CDMRP) that annually funds millions in various urologic research programs. Sen. Blackburn has been a longtime supporter of various issues important to urology. While in the House, she was the original champion of the USPSTF Transparency and Accountability Act, and has championed medical liability reform via the Good Samaritan Health Professionals Act. She now serves on the Senate Committee on Veteran’s Affairs. Learn more about AUAPAC.
Congressional Outreach: Alliance of Specialty Medicine Meet & Greet with Physician Legislator
On June 27, the AUA participated in a meet & greet with first-term Congressman Rep. John Joyce, MD (R-PA-13). Rep. Joyce graduated with a biology degree in 1979 from Penn State University, he continued his education at Temple University receiving his MD in 1983. Subsequently, he completed a three-year internal medicine residency as a Johns Hopkins fellow and then completed a residency in Dermatology at Johns Hopkins finishing as chief resident. Dr. Joyce is a fellow in the American College of Physicians and the American Academy of Dermatology.
His near-term goal is to land a seat on the House Energy & Commerce Committee where he can work more closely with provider groups such as the AUA on health policy matters. During the meeting there was a lot of discussion around the surprise medical billing issue, where he indicated (as a physician) that he is very much in favor of arbitration-style legislation vs. a fixed price rate mechanism to resolve billing issues between the provider and insurer. Other topics of discussion included the need to streamline the prior authorization process and working to solve physician burnout issues around the country.
Prior Authorization: AUA Continues Coalition Work on House Legislation
The AUA, along with other members of the Regulatory Relief Coalition, met with Reps. Mike Thompson (D-CA-5) and Jimmy Gomez (D-CA- 35) to discuss the Improving Seniors’ Timely Access to Care Act (H.R. 3107), which would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under Medicare Advantage. In the coming weeks, the AUA will work with coalition members to garner congressional support for the bill. (More information here.) In the meantime, 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.
Insurance Updates: Week of July 1, 2019
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes important information from Aetna and its updated Benign Prostatic Hyperplasia (BPH) policy, as well as information from the Centers for Medicare & Medicaid Services regarding the new HCPCS code J9030 for BCG. We have also included information for reporting BCG during the drug shortage. A few more updates include carriers such as the University of Pittsburgh Medical Center (UPMC) Health Plan, Horizon BCBS New Jersey, BCBS Mississippi and Centene Corporation. Read more here.
Practice Management: Join the Practice Managers’ Network, AUA’s Regional Coding Seminar
For a limited time, Practice Managers’ Network (PMN) subscriptions are available at a discounted rate. Find out why you should subscribe your practice to the PMN. Are you looking for support with your administrator duties and wish you had a network of peers to keep you updated on current urology management trends and issues? Would your staff benefit from professional coding reviews on denials and tough billing questions? Let the Practice Managers’ Network (PMN) provide the support your practice needs for the rest of 2019 at a discounted $199 (regular $349). With a PMN subscription, you receive: Unlimited Expert Coding Advice through the AUA Coding Hotline operated by CPC and ICD-10-CM certified staff, Practice Managers' Network Online Community, PMN E-News monthly email newsletter, PM Coding Chat, PMN Podcast Series, and discounts on PM conferences, seminars and products. If you are not yet a part of this valuable network, this is an ideal opportunity to take advantage of and set your practice up for success! Discounted rates will only be available for a limited time! Please contact email@example.com or subscribe Practice Mangers’ Network .
Get the latest on urology coding from AUA experts at the 2019 AUA Coding Seminar on July 19- 20, at the Westin Las Vegas Hotel in Las Vegas, Nevada. This seminar is designed to update your CPT coding skills and hone your ICD-10 coding skills and will extend your urology coding knowledge beyond the textbook and into the realm of key practice issues, audit-proofing, and more.
In addition to the seminar, Friday workshops will offer an Auditing Workshop, Surgical Procedure Coding Workshop and Practice Essentials Seminar workshop which will feature a half day program for attendees on how to promote effective practices, make effective finical decisions, and 2019 audit targets for practices. Explore the Agenda of the main course, which include lectures from PRS Network president Mark Painter, and certified AUA faculty. Physician’s CME and Coder's CEUs are available. Register now to avoid being left out on this valuable coding information for yourself and your practice. It is easy to bring your entire coding team; the AUA is offering special discounts for practices who wish to bring additional employees to the seminar. To register or learn click here.