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Independence Blue Cross Oral Oncology Agents Pharm Policy:  Independence Blue Cross (IBX) has updated the changes to policy scope, adding Erleada to the policy. Erleada is indicated for the treatment of non-metastatic castration-resistant prostate cancer.  This oncology agent is approved when one of the following inclusion criteria is met: Drug is FDA-approved for indication and regimen requested, including confirmation by genetic and/or biomarker testing when appropriate; or The indication and regimen are classified as Category 1 or 2A by National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium™; or The narrative ...
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This update includes news from the American Medical Association’s House of Delegates meeting as well as news on our Insurance Roundtable with more than 33 commercial insurers, Medicare Administrative Contractors, and specialty societies. AMA House of Delegates Interim Meeting Recaps AUA Delegates Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, Resident and Fellow Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – joined hundreds of physicians at the American Medical Association (AMA) House of Delegates 2018 Interim Meeting to consider resolutions and reports covering clinical practice, payment, ...
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On November 9, the AUA hosted its first insurance roundtable, bringing together representatives from commercial insurers, Medicare Administrative Contractors (MACs) and specialty societies to discuss issues of mutual concern, such as prior authorization, telemedicine and coverage issues. Over the course of the day, specialty society representatives engaged with leaders from Aetna and UnitedHealth Group for a full day of panel discussions and dialogue around topics of import to both private insurers and MACs. Additional topics addressed included: Medicare Advantage plans; Implementation and restraints for new technologies; Use of mid-level providers; ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, 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 Interim Meeting to consider resolutions and reports that would establish policy on health, medical, professional and governance matters. Regular updates were posted to the Policy & Advocacy Brief blog over the course of the meeting and can be reviewed here . Recap: Days 3 and 4:   On November 12-13, the AUA delegates ...
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Blue Cross Blue Shield Alabama Prostatic Urethral Lift:   Blue Cross Blue Shield Alabama BCBSAL has reviewed its prostatic urethral lift medical policy with the following changes to criteria and supporting information: Clarified criterion regarding persistent or progressive lower urinary tract symptoms (LUTS) to add language indicating "despite medical therapy" as an alternate to intolerance of medical therapy; Updated description of procedure or service section to remove information on the NeoTract UroLift System; Updated key points section to include supporting information regarding the clinical context and therapy purpose, relevant population, ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, 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 Interim 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, November 11 Recap Various measures pertinent ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, 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 Interim 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, November 10 Recap The AUA participated in a spirited discussion ...
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On October 9, Minnesota urologist Dr. Dean Tortorelis participated in an important roundtable conversation with Rep. Erik Paulsen (R-MN-3) on the topic of step therapy. Dr. Tortorelis, who practices with Minnesota Urology, participated on behalf of the AUA and provided an important perspective on the impacts that step therapy has on patient access, interaction with physicians and its effect on physician morale. We recently spoke with him to discuss his experience and why the urology community should be active advocates. Q1: Tell about your roundtable experience with Rep. Paulsen. Why was it important for this conversation to take place? A: The experience ...
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The AUA is now offering a manual entry Merit-based Incentive Payment System (MIPS) reporting option to urologic care providers who are unable to report electronically through the AQUA Registry. Providers electing to utilize AUA’s MIPS Manual Entry Webtool will have the opportunity to report on both Quality Payment Program (QPP) and non-QPP urology-specific measures that are most relevant to urologic care providers. The webtool is an online portal through which providers enter data, manually, directly into the system. Data entered are strictly used for MIPS reporting purposes. The manual entry webtool is not affiliated with the AQUA Registry. Practices wishing ...
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The AUA recently awarded seven scholarships to the upcoming 2018 Quality Improvement Summit, entitled Opioid Stewardship in Urology , on Saturday, December 8, 2018.  The scholarship program provides travel assistance to residents and/or fellows enabling them to attend the event.  The recipients will be involved in the Summit in a variety of ways including speaking at the event, summarizing their takeaways from the conference, and working on the Summit proceedings papers.  2018 Quality Improvement Summit Award Winners Christi Butler, MD – Dr. Butler is currently in residency at University of California, San Francisco and is also working on a certificate ...
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This week’s update includes information on the upcoming American Medical Association House of Delegates meeting, our analysis of the final rule for the Medicare Physician Fee Schedule, and this week’s Insurance Roundtable. AMA House of Delegates: AUA Physicians Preparing for Upcoming Interim Meeting On October 23, AUA Delegates Drs. Aaron Spitz and Willie Underwood, AUA Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident & Fellow Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Rayburn held their resolutions review call in preparation for the AMA House of Delegates Interim Meeting at the National Harbor ...
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First Coast Service Options Anorectal Manometry and Electromyography (EMG) of the Urinary and Anal Sphincters - Draft LCD (DL37943): First Coast Service Options has released a draft local coverage determination for Anorectal Manometry and EMG of the Urinary and Anal Sphincters.  The contractor proposes medically necessary therapies and indications including: Anorectal manometry for the following indications: Constipation fecal incontinence EMG studies of the external anal sphincter for the following indications: Constipation fecal incontinence EMG studies of the external urethral sphincter for the following indications: lower ...
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The Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2019 Medicare Physician Fee Schedule on November 1, 2018. The rule also includes changes to E/M documentation and coding, updates to the Quality Payment Program and Part B payment policies. Here’s how the proposed and final rules compare: Conversion Factor  Final 2018 Conversion Factor: $35.9996 Final 2019 Conversion Factor: $36.0391   Learn how the conversion factor affects payment. Increase in Allowable Charges for Urology      CMS estimates that the final Fee Schedule changes will result in a positive, 1 percent ...
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On November 1, the Centers for Medicare & Medicaid Services (CMS) released the final 2019 Medicare Physician Fee Schedule. The final rule outlined the agency's plan to delay significant E/M coding changes. Read more specifics about the changes here . How did the AUA reach its decision to support a delay in the proposed E/M changes? More than a dozen members of the AUA’s RUC Workgroup, CPT Advisors, Coding and Reimbursement Committee, Telemedicine Workgroup, and Regulatory Workgroup analyzed CMS’ proposals and raised concerns. Of most concern was the potential impact on practices that treat the sickest patients –who require longer, more complicated ...
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On November 1, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2019 Medicare Physician Fee Schedule. The AUA is in the process of reviewing the complete rule, but we wanted to make you aware that CMS has delayed some of its proposed changes to Evaluation & Management (E/M) coding. This delay directly reflects the response of the AUA and more than 150 organizations that shared our concerns that the proposed payment changes could result in unintended financial impacts over the long term. While we agree conceptually with a proposal to simplify coding for services to reduce physician burden, the AUA believes there were ...
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This week’s update includes information on meeting with the Department of Defense’s Congressionally Directed Medical Research Program Director and our partnership with Congressional offices to advocate against step therapy as a cost savings option. Patient & Research Advocacy Update: AUA Meets with CDMRP Director, Attends Forum on Shared Decision Making On October 26, the AUA joined its colleagues at the Defense Health Research Consortium to meet with Colonel Stephen J. Dalal, the new director of the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP). The purpose of the meeting was to discuss the future of the CDMRP and ...
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Blue Cross Blue Shield Arizona Sipuleucel-T (Provenge): Blue Cross Blue Shield Arizona (BCBS AZ)has added criteria requiring member to have no evidence of visceral metastatic disease (from imaging studies), requiring that the member is not using systemic corticosteroids or immune-suppressing therapy, and requiring that the member is not using other chemotherapy for prostate cancer. BCBS AZ has also added an initial approval duration section indicating that approval duration is eight weeks to receive three complete doses with no renewal or continuation period. A statement was added indicating that if the member is unable to receive their scheduled infusion, ...
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This week’s update includes information on addressing Accountable Care Organizations (ACOs) that operate under the Medicare Shared Savings Program, as well as insurance updates pertaining to urology. AMA RUC Surveys Launched! Please Participate If Contacted The AUA has issued requests for AMA/Specialty Society RVS Update Committee (RUC) physician work surveys for five CPT codes. The survey deadline is November 5, 2018. The surveys are for the following procedures due to changes in descriptors, new codes or review of new technology: 52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant 52442 Cystourethroscopy, ...
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Palmetto Oncotype DX Prostate Cancer Assay (MolDX) LCD (L36153): Palmetto has revised its Oncotype Prostate Cancer Assay medical policy with changes to coding and billing instructions due to CPT/HCPCS code changes. They have added the following CPT code to the CPT/HCPCS code section: 0047U  Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score Palmetto has removed the following CPT code from the CPT/HCPCS code section: 81479  Unlisted molecular pathology procedure Palmetto has revised ...
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The American Urological Association will host its fourth Quality Improvement Summit on Saturday, December 8, 2018, focused on opioid stewardship in urology. Angela Smith, MD, MS, Associate Professor of Urology at the University of North Carolina, Chapel Hill, and Gregory Auffenberg, MD, MS, Assistant Professor of Urology at Northwestern University, are serving as the event co-chairs. They took a few moments to talk to the AUA about the upcoming event. Q: With so many other organizations hosting conferences and meetings regarding opioid use disorder, why did the AUA decide to focus on this topic for the 2018 Quality Improvement Summit? The AUA is ...
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