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On September 7, the AUA submitted comments to the Centers for Medicare & Medicaid Services on the proposed rule that provides updates to the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2019, as well as to the Quality Payment Program and other Medicare Part B payment policies. Although the letter provided comment on many changes in the rule, five key areas of focus include: CMS will release the final rule in November 2018. The AUA will compare the proposed and final rule to determine what proposals have been accepted by CMS. Read the full AUA comment letter
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The Food and Drug Administration (FDA) is advising consumers not to purchase several nutritional supplements sold for sexual enhancement because an FDA laboratory analysis confirmed they contain the hidden ingredient sildenafil, an active ingredient in FDA-approved prescription drugs used to treat erectile dysfunction. The supplements include: Extenze Nutritional Supplement Extenze Plus PremierZen Gold 4000 While there are no reports of illness associated with the supplements, they could pose a threat to consumers because the undeclared product can interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower ...
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This week’s update includes information on the Congressional Black Caucus’ men’s health policy session AUA moderated, insurance news, and our role in the Rally for Research advocacy event for an increase in medical research funding for the National Institutes of Health. We also applaud the U.S. House of Representatives’ passage of the Local Coverage Determination Clarification Act (H.R. 3635), which now moves to the Senate for deliberations. Congressional Black Caucus Legislative Conference: AUA Attends, Moderates Men’s Health Panel On September 12-14, the AUA attended the Congressional Black Caucus’ 48th Annual Legislative Conference in Washington, DC ...
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Federal Blue Cross Blue Shield Xtandi: Federal Blue has revised with the following changes to criteria and supporting information: Added criteria for castration-resistant prostate cancer (CRPC) requiring that member is either receiving gonadotropin-releasing hormone (GnRH) or has had a bilateral orchiectomy. Read the complete policy . Highmark Pennsylvania Radiation Therapy for Bone Metastases: Highmark Pennsylvania has added castrate-resistant prostate cancer as an indication for radium-223 which may be considered medically necessary when all criteria are met: The individual has symptomatic skeletal (bone) metastases; and The individual ...
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On September 12-14, the AUA attended the Congressional Black Caucus’ 48th Annual Legislative Conference in Washington, DC (CBC ALC). There were several panel discussions centered on the role urologists play in quickening the pace and widening the scope of men screened and tested for prostate cancer and other commodities, especially for higher at-risk populations. AUA Government Relations manager, Quardricos B. Driskell moderated a conversation during a session entitled CBC Health Braintrust Truth and Reconciliation Commission on Health Equity, where he spoke on men's health policy and medical issues relative to eliminating the prostate cancer racial disparity ...
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This week’s update includes information on the Defense Appropriations Act that is anticipated to adequately fund the Congressionally Directed Medical Research Programs and information about this week’s Rally for Research on Capitol Hill. Patient and Research Advocacy: Partner and Coalition Activity On September 7, the AUA participated in the Defense Health Research Consortium’s (DHRC) member meeting. The meeting provided a status update on the Fiscal Year 2019 Department of Defense Appropriations Act, which must be enacted before the current fiscal year ends at the end of the month. Conferees are deliberating on the measure this week, which, in its current ...
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Tufts Health Plan Avoiding Claim Denials: Tufts Health Plans has revised its Avoiding Claim Denials medical policy with the following changes to denial reasons and template. Added 'no supporting documentation provided' as a denial reason with associated tips to avoid administrative denial for this reason. Added 'no referral on file' as a denial reason for Tufts Health Public Plans products, indicating some members may require a referral which can be checked on Tufts Health Provider Connect, on a member’s ID card of by calling provider services. Added tips to avoid no referral on file as a reason for an administrative denial. Updated 'timely filing ...
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The Centers for Medicare & Medicaid Services (CMS) will reverse a medically unlikely edit (MUE) that has resulted in denials for some claims reporting more than four implants (HCPCS code L8699 prosthetic implant, not otherwise specified ) when coding for the prostatic urethral lift (PUL) (UroLift®) procedure in the hospital outpatient department.This MUE -- erroneously assigned as part of the April 2017 National Corrective Coding Initiative edits– will be corrected starting January 1, 2019 and will have a retroactive date of April 1, 2018. Coding for Prostatic Urethral Lift Billing Medicare for the prostatic urethral lift (C9739 Cystourethroscopy, ...
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The AUA has released a new position statement on opioid use .  Developed by a workgroup of experts, the statement addresses opioid duration and amount, Prescription Drug Monitoring Programs, use of opioids in the setting of chronic use or substance abuse disorder, risks, storage and proper disposal, and non-legitimate access to opioids. The statement aims to balance the role of urologists in reducing their patients’ pain while also avoiding overprescribing of opioids. The AUA’s additional efforts around curbing the overuse of opioids will include a Quality Improvement Summit on Opioid Stewardship in Urology on December 8, 2018. Held at the AUA headquarters ...
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The U.S. Food and Drug Administration (FDA) has issued a warning about cases of necrotizing fasciitis (Fournier’s gangrene) of the perineum in patients taking sodium-glucose cotransporter-2 (SGLT2) inhibitors . The FDA is requiring a new warning about this risk to be added to the prescribing information of all SGLT2 inhibitors and to the patient Medication Guide . SGLT2 inhibitors are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine. First approved in 2013, medicines in the SGLT2 inhibitor class ...
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The Medicare Payment Advisory Commission (MedPAC) recently requested a meeting with various surgical specialty societies, including the AUA, to discuss the future of the Merit-based Incentive Payment System (MIPS) and the value of registries in quality improvement. MedPAC, an independent congressional agency that advises Congress on Medicare issues, has recently spoken out against MIPS , questioning its effectiveness and long-term feasibility. The AUA joined others in a meeting with MedPAC on September 20. In strategizing alternatives to MIPS, MedPAC was interested in speaking with surgical societies about their Qualified Clinical Data Registries (QCDRs) ...
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Quality improvement and patient safety is playing a larger role in physician education. Because of this and the AUA’s interest in involving residents and fellows in all educational endeavors, the AUA will award resident and fellow travel scholarships to its upcoming Quality Improvement Summit. Apply now for this opportunity. The Quality Improvement Summit will take place on Saturday, December 8, at AUA headquarters in Linthicum, MD, and will focus on opioid stewardship in urology. Speakers will include a combination of healthcare providers such urologists, anesthesiologists, plastic surgeons, and pain management and addiction specialists, in addition to ...
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Final scores and performance feedback for the 2017 Merit-based Incentive Payment System (MIPS) are now available for review on the Quality Payment Program website . If any MIPS participants believe their final scores are incorrect, they should contact the Centers for Medicare & Medicaid Services (CMS) to request a targeted review. The final scores are used to calculate 2019 payment adjustments, and this positive, negative, or neutral payment adjustment will be applied to the amount received from Medicare for covered professional services furnished under the Medicare Physician Fee Schedule in 2019. The AUA urges members to request a targeted review and correct ...
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The Food and Drug Administration (FDA) is advising consumers not to purchase or use a group of supplements promoted for sexual enhancement because an FDA laboratory analysis confirmed they contain undeclared sildenafil.  5K Ding Ji Wei Ge Panther Power Platinum 11000 XXXPlosion Ultra Sildenafil is a FDA-approved pharmaceutical ingredient used to treat erectile dysfunction. While there are no reports of illness associated with the list of supplements, they could pose a threat to consumers because the undeclared product can interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous ...
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This week’s update includes information on our ongoing advocacy to address prior authorization burdens and improve urologic care for our veterans. Prior Authorization: AUA Works to Push Bipartisan Letter on Capitol Hill Last week , we informed you of a congressional sign-on letter, drafted by Phil Roe, MD (R-TN-1) and Ami Bera, MD (D-CA-7), requesting that the Centers for Medicare & Medicaid Services (CMS) address the prior authorization process under Medicare Advantage plans. To promote the letter, on August 28-30, the AUA met individually with staff in the offices of Reps. Darin LaHood (R-IL-18), Devin Nunes (R-CA-22), and Neal Dunn, MD (R-FL-2). ...
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United Healthcare Genetic and Molecular Testing Prior Authorization/Notification Updates: Effective Oct. 1, 2018, United Healthcare (UHC) will require prior authorization/notification for additional codes as part of the online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for fully insured United Healthcare commercial plan members. After providers notify UHC of these procedures, UHC will provide notification if a clinical coverage review is required as part of the advance notification/prior authorization process and what additional information is needed. The medical policy that applies to ...
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This week’s update includes information on our advocacy to oppose a Centers for Medicare & Medicaid Services policy allowing Medicare Advantage Plans to use step therapy for Part B covered drugs, to support several provisions of the Medicare Physician Fee Schedule on telemedicine and to support of the Good Samaritan Health Professionals Act. Stark Law: Alliance of Specialty Medicine, AUA Urge Exemptions for those in Alternative Models Last week, the AUA joined its colleagues in the Alliance of Specialty Medicine in signing on to a letter responding to the Centers for Medicare & Medicaid Services’ (CMS) request for information regarding the physician ...
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The AUA currently is running a grassroots campaign to urge support of the “Good Samaritan Health Professionals Act” (S. 781). The request is to have the bill included in the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPA). The Good Samaritan Health Professionals Act would help ensure patients have access to vital, on-site medical services in the wake of a natural or man-made disaster. Adopting the Good Samaritan legislation would help protect medical volunteers from lawsuits during a large-scale disaster or national emergency. We are asking that you please contact your Senators and ask them to cosponsor S. 781, the Good Samaritan Health Professional ...
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Telemedicine Workgroup co-chairs Drs. Eugene Rhee and Aaron Spitz, Regulatory Workgroup chairs Drs. Josh Langston and CJ Stimson, Coding and Reimbursement Committee Chair Dr. Jonathan Rubenstein, AUA CPT Advisor Dr. Ron Kaufman and Regulatory Workgroup member Dr. Matthew Gettman prepared draft comments on three provisions of the Centers for Medicare & Medicaid Services’ (CMS) Medicare Fee Schedule Proposed Rule: Non face-to-face communication to assess whether the patient needs an office visit (Virtual Check In), Remote Evaluation of Pre-Recorded Patient Information, and the Interprofessional Check In. Over the next week, AUA policy analysts and certified ...
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CGS Administrators Rezum System for Benign Prostatic Hyperplasia: CGS Administrators has issued a new Supplemental Article for the correct coding and Medicare billing procedures for the Rezum system. Hospital Outpatient Setting or Ambulatory Surgical Center: Effective January 1, 2018, claims billed for procedures involving Rezum should be coded as HCPCS C9748. Documentation must be included in the remarks field (Field Locator 80) on the UB-04 (CMS 1450 form) or the equivalent 5010 electronic claims   Physician’s Office:  Claims billed for procedures involving Rezum should be coded as CPT 53899. Documentation must be included in ...
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