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On July 11, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2019 Medicare Physician Fee Schedule, which also includes updates to the Quality Payment Program (QPP) and other Medicare Part B payment policies. The rule outlines a number of important changes of which urologists should be aware. Reduced E&M Documentation Burden CMS is proposing a number of coding and payment changes that the agency says will reduce administrative burden and improve payment accuracy for Evaluation and Management (E&M) visits. Proposed changes include the following: Giving providers greater flexibility for E&M documentation. ...
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This week’s update includes an update on Congressional funding for urology research as well as our comments to the Department of Health and Human Services about its Blueprint to Lower Drug Costs and Reduce Out-of-Pocket Costs, also known as American Patients First. Urology Research Funding: Prostate Cancer Highlighted in House Appropriations Report The House of Representatives Committee on Appropriations recently released its draft report for the FY2019 Labor-HHS-Education appropriations bill. In it, the committee calls for an increase of more than $1 billion from the current funding level to the National Institutes of Health (NIH), with $100 million going ...
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Recently, the Department of Health and Human Services (HHS) issued a request for information (RFI) to the healthcare community and general public on how it might lower drug prices and reduce out-of-pocket costs. In order to strengthen its voice, the AUA joined its colleagues at the Alliance of Specialty Medicine on a group comment letter in response to the RFI. The letter comments on six areas within the RFI that have direct affect over the patient base the differing specialties within the Alliance serve. Those being moving drugs from Medicare Part B to Part D; a Medicare Part B Competitive Acquisition Program (CAP); site neutrality; copay discount cards; ...
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Highmark PA Medicare Advantage Assistant at Surgery Services: Highmark PA Medicare Advantage has added criteria stating the “AS” modifier (assistant surgery) must be reported on the claim for when billing for a physician assistant (PA), certified registered nurse practitioner (CRNP), or clinical nurse specialist (CNS).  They have also added criteria stating a doctor of medicine/doctor of osteopathic medicine should not submit the “AS” modifier because it is only valid for use by non-physician practitioners when billing under their own provider number. Read the complete policy. Harvard Pilgrim Benign Prostatic Hypertrophy Policy: Harvard Pilgrim ...
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The Centers for Medicare & Medicaid Services (CMS) was recently notified that many of the specialty measure sets listed on the Quality Payment Program (QPP) website contained errors. Some providers use these lists as guides when selecting the measures they will use to participate in QPP. While CMS corrected most of these problems, the AUA verified that errors still exist in the urology measure set. Specifically, four measures are missing: Measure 436 Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques Measure 453 Proportion Receiving Chemotherapy in the Last 14 Days of Life Measure 454 Proportion of Patients Who Died from ...
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The AUA has issued requests for AMA/Specialty Society Relative Value Scale Update Committee (RUC) physician work surveys for four CPT codes. The surveys are for the following procedures: 11981 Insertion, non-biodegradable drug delivery implant 11982 Removal, non-biodegradable drug delivery implant 11983 Removal with reinsertion, non-biodegradable drug delivery implant 74425 Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation Participants are selected randomly from the AUA member database. If you have been asked to participate in the physician work survey and you perform the procedure, ...
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The AUA Coding Hotline has received an increase in phone calls concerning appropriate code use for evaluation and management services. Evaluation and management (E&M) services describe the time and work involved when a provider evaluates a patient’s condition(s) and determines the management of care required to treat the patient.  Evaluation and management services are among the most used codes in the CPT ® codebook, and can be provided in a variety of locations such as a provider’s office, urgent care clinic, or hospital, to name a few. The determination of the correct E&M code is dependent upon many factors. Your CPT ® codebook provides steps for ...
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Are you curious about how the regulation and reimbursement process works but not quite sure where to start? The AUA has developed a new guide to help urology practices better understand how laws, regulations, policies and payments are interconnected, and the critical role the AUA plays in the path to physician payment. In addition to providing in-depth information about the federal rule-making process, this resource provides important information about Current Procedural Terminology (CPT) codes -- including how they are developed and valued. This free resource is available to all members and is available here
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This week’s update notifies you about the AMA/Specialty Society Relative Value Scale Update Committee (RUC) physician work surveys on four CPT codes as well as our support for the Building a Health Care Workforce for the Future Act (S. 3095) and a bill (H.R. 4841) requiring electronic prescription programs to enable the secure transmittal of electronic prior authorizations. Update on AUA Outreach to MedPAC on PSA Testing Shortly after release of the U.S. Preventive Services Task Force’s (USPSTF) final recommendations on screening for prostate cancer in April, we shared that the AUA continues to communicate with the Medicare Payment Advisory Commission ...
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In response to ongoing Medicare Payment Advisory Commission (MedPAC) discussions about low-value care and a recent proposal to classify prostate-specific antigen (PSA) testing as a low-value service, on June 21 the AUA issued a new letter to the commission to reiterate and expand upon our position that access to PSA testing should not be reduced. This letter shares with the commissioners the newly released recommendations on prostate cancer screening from the U.S. Preventive Services Task Force (USPSTF). These recommendations recognize the net benefit of screening in men ages 55 to 69 and promote shared decision making for patients. “Given the recognized ...
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Blue Cross Blue Shield Arizona Percutaneous Tibial Nerve Stimulation (PTNS): Blue Cross Blue Shield Arizona (BCBSAZ) has revised its criteria to include a status change for its medical policy on percutaneous tibial nerve stimulation (PTNS). The status has been changed from “experimental or investigational” to “medically necessary” for an initial 12-week treatment of non-neurogenic urinary dysfunction when criteria are met. BCBSAZ has also added medically necessary criterion for maintenance therapy using monthly PTNS for improved non-neurogenic urinary dysfunction given that treatment goals are met. Read the complete policy. Noridian Required ...
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The AUA's 2018 Quality Improvement Summit will address one of the most prominent topics in medicine today: stewardship of opioid medications. This special event will focus on urology's role in addressing this growing epidemic. The Summit will be held at the AUA headquarters in Linthicum, MD on December 8, 2018. The cost to register is $25, and CME credit is available. Speakers will include a combination of healthcare providers such as urologists, anesthesiologists, plastic surgeons, and pain management and addiction specialists, in addition to researchers, policy makers and others. Their discussions throughout the day will focus on four primary goals: ...
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Registration is required for groups that intend to use the Centers for Medicare & Medicaid Services’ (CMS) Web Interface and/or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey for 2018. The registration period is open through June 30, 2018. Visit the Quality Payment Program website to register . Registration is not required for any other submission methods. Please note, if a group was registered to participate in MIPS in 2017 via the CMS Web Interface, CMS will automatically register the group for 2018 CMS Web Interface participation. Groups may edit or cancel this automatic ...
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Performance scores for 2016 are now available for download via the Physician Compare Downloadable Database at Data.Medicare.gov . The information in the Downloadable Database includes: 2016 Physician Quality Reporting System (PQRS) measures for clinicians and groups 2016 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS summary survey measures for groups 2016 non-PQRS Qualified Clinical Data Registry (QCDR) measures for clinicians and groups Subset of 2015 utilization data for clinicians The Centers for Medicare & Medicaid Services (CMS) created Physician Compare in order to provide patients with useful information about ...
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This week’s update includes information our final summary from last week’s American Medical Association House of Delegates meeting and Fiscal Year 2019 Research Funding Allocations. AMA House of Delegates: Summary of the Annual Meeting On June 9-13, the American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident and Fellow Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – joined nearly 600 other physicians at the American Medical Association’s (AMA) House of Delegates 2018 Annual Meeting to consider resolutions and reports ...
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Each week, the AUA publishes weekly updates on the lasted insurance issues pertaining to urology. This week’s update includes information on Aetna’s revision to its Erectile Dysfunction medical policy, as well as Blue Cross BlueShield of Alabama’s Prostatic Urethral Lift medical policy change. Aetna Erectile Dysfunction (ED): Aetna has revised its Erectile Dysfunction Policy to state that the following are considered experimental and investigational: botulinum toxin for the treatment of ED; and the use of serum biomarkers (e.g., E-selectin, endothelial progenitor cells, endothelial micro-particles, interleukin-10, malondialdehyde, nitric oxide, ...
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This week’s update includes information on the 2019 National Defense Authorization Act and research funding, updates from the American Medical Association’s House of Delegates meeting, and insurance updates pertaining to urology. American Medical Association House of Delegates Meeting: Prostate Cancer Screening and Hazardous Drugs Among Hot Topics in Urology AUA delegates Drs. Aaron Spitz and Willie Underwood, Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident & Fellows Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn continue to push urology’s agenda forward at the AMA’s House of Delegates ...
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Blue Cross Blue Shield Rhode Island Temporary Prostatic Stent: Blue Cross Blue Shield Rhode Island has updated its Temporary Prostatic Stent Medical Coverage Policy to change the coverage criteria from “not medically necessary” to “medically necessary” for its Medicare patients. This change is not applicable for commercial plans; BCBS Rhode Island revised its “not medically necessary” policy statement to state the evidence is insufficient to determine the effects of this technology on health outcomes. Previously, BCBS Rhode Island stated there is insufficient peer-reviewed scientific literature to demonstrate that the procedure/service is effective, which ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident and Fellow Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – have joined nearly 600 other physicians at the American Medical Association’s (AMA) House of Delegates 2018 Annual Meeting to consider resolutions and reports that would establish policy on health, medical, professional and governance matters. Regular updates will be posted to the Policy & Advocacy Brief blog over the course of the meeting. Read the Day 1 recap . Sunday, June 10 AUA members ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident and Fellow Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – have joined nearly 600 other physicians at the American Medical Association’s (AMA) House of Delegates 2018 Annual Meeting to consider resolutions and reports that would establish policy on health, medical, professional and governance matters. Regular updates will be posted to the Policy & Advocacy Brief blog over the course of the meeting. Saturday, June 9 The AUA rose to the microphone to ...
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