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In 2019 there are several ways to earn bonus points in the Merit-based Incentive Payment System (MIPS), and one involves complex patients. The Centers for Medicare & Medicaid Services (CMS) recognizes the risk factors incurred by clinicians who care for medically complex patients. Therefore, CMS will analyze a clinician’s data to determine if complex patient bonus points are appropriate. The bonus is based upon the Hierarchical Condition Category (HCC) (a risk adjustment model using patient diagnoses and demographic information to predict medical spending) scores as well as socio-economic risk based upon the proportion of patients with dual Medicare-Medicaid ...
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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 ...
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This week’s update includes information on the Senate HELP Committee healthcare package, new PCORI legislation and updates on the recent 2019 AMA House of Delegates meeting. Congratulations to Dr. Willie Underwood for a successful campaign and election to the American Medical Association Board of Trustees! ( See related article .) American Medical Association: AUA Updates from the House of Delegates The American Urological Association’s Delegates – Dr. Aaron Spitz and Dr. Willie Underwood, Alternate Delegates Dr. Terry Grimm and Dr. Jason Jameson, Resident and Fellow Delegate Dr. Hans Arora and AUA President-Elect Dr. Scott Swanson joined hundreds of physicians ...
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On June 11, New York urologist Dr. Willie Underwood was elected to the American Medical Association (AMA) Board of Trustees. Dr. Underwood is the first urologist on the Board of Trustees since Dr. Frank Jirka, a Chicago urologist, served as its president from 1983-1984. Dr. Underwood has represented the American Urological Association as a delegate to the AMA House of Delegates for many years, and is a long-standing advocate for issues affecting urologists and their patients. “I ran for the AMA Board because I believe in the African proverb, ‘if you want to go fast, go alone. If you want to go far, go together,’” Dr. Underwood said. “I am hopeful that other ...
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The American Urological Association’s Delegates – Dr. Aaron Spitz and Dr. Willie Underwood, Alternate Delegates Dr. Terry Grimm and Dr. Jason Jameson, and Resident and Fellow Delegate Dr. Hans Arora – have joined the American Association of Clinical Urologists, various urologists practicing around the country, and hundreds of other physicians at the American Medical Association (AMA) House of Delegates 2019 Annual Meeting to consider resolutions and reports covering clinical practice, payment, medical education, and public health topics. View our previous updates here and here . On June 11, AMA leadership election results were shared with the full house. ...
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The American Urological Association’s Delegates – Dr. Aaron Spitz and Dr. Willie Underwood, Alternate Delegates Dr. Terry Grimm and Dr. Jason Jameson, and Resident and Fellow Delegate Dr. Hans Arora – have joined the AACU, Urology Caucus, and hundreds of physicians at the American Medical Association (AMA) House of Delegates 2019 Annual Meeting to consider resolutions and reports covering clinical practice, payment, medical education, and public health topics. View our update from the first two days of the meeting. On June 10, the AUA delegates spent the day in the general session where the AUA delegation and dozens of others debated and voted on resolutions. ...
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Horizon BCBS New Jersey Firmagon: Horizon Blue Cross Blue Shield of New Jersey has reviewed and revised its Firmagon medical policy with the following changes to the policy:   Added medically necessary policy statement for Firmagon for annual renewal when member meets all of the following criteria: tumor response with stabilization of disease or decrease in the size of the tumor or tumor spread; and absence of unacceptable toxicity from the drug (i.e. hypersensitivity reactions, QTc prolongation). Added medically necessary off-label use option for Firmagon stating prostate cancer when used for progressive castration-naïve disease in combination with ...
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The American Urological Association’s Delegates – Dr. Aaron Spitz and Dr. Willie Underwood, Alternate Delegates Dr. Terry Grimm and Dr. Jason Jameson, Resident and Fellow Delegate Dr. Hans Arora and AUA President-Elect Dr. Scott Swanson – have joined hundreds of physicians at the American Medical Association (AMA) House of Delegates 2019 Annual Meeting to consider resolutions and reports covering clinical practice, payment, medical education, and public health topics. Regular updates will be posted to the Policy & Advocacy Brief blog over the course of the meeting. (Read updates from Day 3 and Day 4 .) The AUA rose to the microphone to address the ...
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On June 3, after several years of work by the AUA and other physician groups including the American Medical Association (AMA), the U.S. Pharmacopeia announced revisions to its guidance that better aligns requirements for nonsterile and sterile drug compounding (General Chapters <795> and <797>) with requirements for hazardous drug handling in healthcare settings (General Chapter <800>). Staff and leaders participated in a call with USP on June 3 to review these updates. Most importantly, these revisions delineate between drugs being compounded and those being prepared for immediate use according to manufacturers’ label specifications to a ...
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New data highlights the need for prior authorization reform to ensure patients' timely access to medically necessary care. The Regulatory Relief Coalition, a group of eight national medical specialties including the AUA, today pledged support for the bipartisan Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107), legislation that would protect patients from unreasonable Medicare Advantage plan requirements that needlessly delay or deny access to medically necessary care. Reps. Suzan DelBene (D-WA-01), Ami Bera, MD (D-CA-07), Roger Marshall, MD (R-KS-01) and Mike Kelly (R-PA-16) sponsored the legislation. Currently, Medicare Advantage plans require ...
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As part of the 2019 Merit-based Incentive Payment System (MIPS) requirements, all Promoting Interoperability Programs participants must use 2015 Edition certified electronic health record technology (CEHRT). The Centers for Medicare & Medicaid Services (CMS) believes the up-to-date standards and functions of 2015 Edition CEHRT will better support interoperable exchange of health information and improve clinical workflows. Those that do not use 2015 Edition CEHRT will receive a zero for Promoting Interoperability, which accounts for 25 percent of the overall MIPS score. Providers must participate in Promoting Interoperability for a minimum of 90 continuous ...
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Have any questions about the 2019 Merit-based Incentive Payment System (MIPS)? Seize the opportunity to ask your questions directly to Centers for Medicare & Medicaid Services (CMS) staff during a webinar hosted by the AUA on Tuesday, June 18, 2019, beginning at 1:00 p.m. Eastern. The webinar will feature MIPS content experts who will explain the MIPS program and answer questions. Register now at Quality@AUAnet.org . MIPS reporting requirements in 2019 are more extensive than those in previous years.  So, it is important to learn what you need to do and implement required procedures and changes. The session will review all four reporting components: ...
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The Food and Drug Administration (FDA) announced several supplements promoted for sexual enhancement have been found to contain undeclared active ingredients.  The presence of the undeclared active ingredients renders the products unapproved drugs for which safety and efficacy has not been established and, therefore, subject to recall. STIFF BOY LLC is voluntarily recalling The Beast because an FDA laboratory analysis found the supplement contains undeclared sildenafil.  Additional FDA laboratory analyses found that Man Fuel Xtreme Edition contains sildenafil, dithiodesmethyl carbodenafil and desmethyl carbodenafil and Man Fuel Shooter contains tadalafil ...
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This week’s update includes information on the AUA Summit “ask” to streamline the prior authorization process in the Medicare Advantage program as well as our coalition advocacy to implement the information blocking provisions of the 21 st Century Cures Act. Prior Authorization: Legislation/AUA Summit “Ask” Introduced This Week A bill to streamline the prior authorization process in the Medicare Advantage program was introduced on June 5 in the U.S. House of Representatives. You may recall this topic was one of three main leave-behind issues that were shared with legislators and their staff by attendees of the 2019 AUA Summit. The bill, titled Improving ...
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Health Alliance Plan of Michigan Botulinum Toxin: Health Alliance Plan of Michigan has updated its Botulinum Toxin medical policy with the following change in coding: Changed coding heading section from “covered ICD-10 codes requiring prior authorization when used with J0585” to “covered ICD-10 codes requiring prior authorization for treatment.” Read the complete policy. Regence Myobloc: Regence Blue Cross has revised its Myobloc medical policy, clarifying that clinical documentation (including, but not limited to chart notes) must be provided to show that the criterion has been met. Read the complete policy. United Healthcare ...
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This week’s update includes information on advocacy to establish an Office of Men’s Health within the U.S. Department of Health and Human Services, as well as insurance updates relative to changes in payors’ prostatic urethral lift policies.   Office of Men’s Health: AUA Continues to Advocate through Opinion Piece On May 22, FierceHealthcare published an opinion piece – authored by AUA lobbying consultant and former U.S. Representative Dr. Phil Gingrey – supporting establishment of a new federal Office of Men’s Health through the U.S. Department of Health and Human Services. The AUA worked closely with our contract lobbying team, District Policy Group, ...
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Regence Charged Particle Radiotherapy:   Regence Blue Cross Blue Shield has revised its medical policy for Charged Particle Radiotherapy.  The following information must be submitted for review to determine whether policy criteria are met for charged-particle radiotherapy: Identification of the location, extent, and volume of tumor(s) to be treated, The critical structure surrounding the tumor(s) in question, Applicable diagnosis code(s) and descriptions. Read the complete policy here. Medical Mutual Prostatic Urethral Lift (Urolift) for BPH: Medical Mutual Health plan has a new Prostatic Urethral Lift medical policy. The UroLift ...
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Nearly half the 2019 Merit-based Incentive Payment System (MIPS) reporting year is gone.  Are the reporting choices you selected best for your practice?  Will they earn you a positive payment adjustment (bonus)?  Did you still need to get started?  Whether you are new to MIPS reporting or an old pro, there is always room for improvement, and let the AUA help you by attending the AUA MIPS reporting webinar on Tuesday, June 18, 2019, beginning at 1:00 p.m. Eastern. The webinar will feature experts from the Centers for Medicare & Medicaid Services (CMS), who will explain the MIPS programs and answer questions. Register now at Quality@AUAnet.org . MIPS ...
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The AUA is returning to The Westin Las Vegas for our annual Las Vegas Coding Seminar, to be held  July 19-20. Registration for this event is officially open. The seminar will feature experts in the field of urology, who will provide updates on coding changes, discussions of common coding questions and payment denials gathered from the AUA Coding Hotline. Our event is widely praised by its attendees, with one suggesting that they “highly-recommend that physicians, managers, coders and billers of any level should attend.” The seminar will offer practical exercises to hone the skills of anyone in the practice who is involved with CPT, HCPCS, or ICD coding. Our ...
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This week’s update includes information on surprise billing legislation currently under review by the Legislative Affairs Committee and our participation in fly ins hosted by One Voice Against Cancer (OVAC) and RESOLVE: The National Infertility Association and the American Society for Reproductive Medicine. We also share news about the Alliance of Specialty Medicine and AUA’s future meeting with the Centers for Medicare & Medicaid Services to address prior authorization or step therapy protocols that cause delays in treating patients. Surprise Billing: AUA Reviews Legislation Introduced in the Senate On May 16, Sen. Bill Cassidy, MD (R-LA), along with ...
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