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by Eugene Rhee, Co-Chair of the AUA Urology Telehealth Task Force The 2019 American Telemedicine Association (ATA) brought together healthcare professionals and leaders from an array of healthcare and technology sectors, April 14-16 in New Orleans. The American Urological Association sent the AUA Telehealth Task Force delegation to this meeting to learn, innovate, and network. The Task Force returned with actionable insights, lasting connections, and an enhanced appreciation of telehealth. The ATA is a nonprofit association based in Washington, DC, with a membership of more than 10,000 industry leaders and healthcare professionals. The meeting, ...
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BCBS North Carolina Bundling Guidelines: Blue Cross Blue Shield North Carolina has revised their Bundling Guidelines medical policy with the following changes to billing information and coding: Added billing guidelines for remote monitoring of physiologic parameters, Revised billing guidelines for prolonged evaluation and management service to remove the statement indicating the guidelines are consistent for Medicare, Added the following CPT code applicable to care management services, but not eligible for separate reimbursement: 99491 - Chronic care management services, provided personally by a physician or other qualified health care professional, ...
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This week’s update includes information from the Congressional Black Caucus/National Minority Quality Forum Health Disparities Braintrust; two congressional bills addressing the in-office ancillary services exception; as well as insurance updates.   Health Disparities: AUA Attends Congressional Black Caucus (CBC)/National Minority Quality Forum (NMQF) Event On April 8-9, the AUA attended the CBC’s and NMQF’s Summit on Health Disparities and Braintrust. This annual summit aims to assist healthcare providers, professionals, government administrators, researchers, policy makers and community-based organizations in delivering quality care to diverse populations. Several ...
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The Food and Drug Administration (FDA) granted accelerated approval to Balversa (erdafitinib), a treatment for adult patients with locally advanced or metastatic bladder cancer that has a type of susceptible genetic alteration known as FGFR3 or FGFR2, and that has progressed during or following prior platinum-containing chemotherapy. Patients should be selected for therapy with Balversa using an FDA-approved companion diagnostic device. The most common type of bladder cancer is transitional cell carcinoma, also called urothelial carcinoma. Bladder cancers are associated with genetic mutations that are present in the patient’s bladder or entire urothelium ...
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Regence Sacral Nerve Modulation/Stimulation for Pelvic Floor Dysfunction: Regence Blue Cross has revised their Sacral Nerve Modulation/Stimulation for Pelvic Floor Dysfunction medical policy for patients from being not medically necessary to medically necessary if criteria are met.   Regence will determine if criteria are met based on the information presented in the submitted required documents. Required documentation include, but are not limited to, the following: History and physical documenting symptoms (frequency and duration), cause(s), and conditions/indications being treated, as well as failed or inability to tolerate conventional therapy; ...
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        AUA Advocacy Snapshot: Week of April 8, 2019   This week’s update includes information on our congressional advocacy as well as top takeaways from last week’s Medicare Payment Advisory Commission discussion on value-based payment.   Value-based Payment: April 2019 MedPAC Meeting On April 4, AUA Gallagher Scholar Brook Brown, MD, and Payment Policy Manager Keith Hawman attended the Medicare Payment Advisory Commission (MedPAC) meeting. The use of value-based payment (VBP) in Medicare was among the top issues discussed. MedPAC commissioners have a long-standing interest in moving Medicare away from the traditional fee-for-service (FFS) ...
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The Centers for Medicare & Medicaid Services (CMS) April 5 Clinician Outreach Meeting focused on the Open Payments 2019 Updates and the Physician Compare Supplemental 30-Day Preview Period. Open Payments 2019 Updates The Open Payments Data Reporting window closed on March 31, 2019, and the pre-publication data review window for Program Year 2018 is now open through May 15, 2019. Clinicians have a 45-day window of time to review data attributed to them during the reporting period before it becomes available to the public. Clinicians must be registered in the Enterprise Identity Management (EIDM) system, as well as the Open Payments System in order to ...
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Value-based Payment: April 2019 MedPAC Meeting On April 4, AUA Gallagher Scholar Brook Brown, MD, and Payment Policy Manager Keith Hawman attended the Medicare Payment Advisory Commission (MedPAC) meeting. The use of value-based payment (VBP) in Medicare was among the top issues discussed. MedPAC commissioners have a long-standing interest in moving Medicare away from the traditional fee-for-service (FFS) model. Four scenarios were presented that would expand or replace the FFS program: Scenario 1: Medicare continues to operate the traditional (FFS) program. This includes allowing voluntary participation in Medicare Advantage (MA) programs and ...
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This is the first year that Quality Payment Program (QPP) performance information will be publicly reported, and many stakeholders have asked the Centers for Medicare & Medicaid Services (CMS) for additional time to review their data before it is publicly reported on Physician Compare , a website created by CMS to provide patients with useful information about physicians and other healthcare professionals who take part in Medicare. CMS responded by offering a supplemental Physician Compare preview period. All eligible clinicians and groups should check their performance information by logging into the Quality Payment Program website. The supplemental ...
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The Centers for Medicare & Medicaid (CMS) is studying the factors associated with reporting Quality measures in 2019 and is seeking participants for this study. Merit-based Incentive Payment System (MIPS) participants who successfully participate in the CMS study will earn full credit for the 2019 MIPS Improvement Activities performance category (which is 15 percent of the composite score in 2019).  CMS plans to: Study clinical workflows and data collection methods using different submission systems. Understand the challenges participants have when collecting and reporting quality data. Recommend changes to lower participant burden, improve quality ...
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The Food and Drug Administration (FDA) announced that USA LESS is voluntarily recalling LEOPARD Miracle Honey , a supplement promoted for sexual enhancement, because an FDA laboratory analysis found the supplement contains undeclared sildenafil.  The presence of the undeclared active ingredient renders the product an unapproved drug for which safety and efficacy has not been established and, therefore, subject to recall. Sildenafil is an FDA approved drug for the treatment of male erectile dysfunction and is in a class of drugs called phosphodiesterase (PDE-5) inhibitors. While there are no reports of illness associated with the supplement, it could ...
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Blue Cross Blue Shield New York Erectile Dysfunction (ED) Agents: Blue Cross Blue Shield (BCBS) New York has updated its medical policy for Erectile Dysfunction Agents with the following changes to applicable medications, criteria, and supporting information. They have added generic tadalafil, sildenafil and vardenafil to the policy as plan-preferred. Coverage is provided in accordance with the following: For Viagra/sildenafil, Levitra/vardenafil, Cialis/tadalafil, Staxyn, Stendra, Muse, Caverject, or Edex for the treatment of erectile dysfunction. For Cialis/tadalafil 2.5mg or 5mg tablets for the treatment of benign prostatic hyperplasia Phosphodiesterase ...
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This week’s update includes information on our congressional outreach on the USPSTF Transparency and Accountability Act as well as updates on two of our 2019 AUA Summit hottest issues: the bacillus Calmette-Guerin (BCG) shortage and communications with the US Pharmacopeia. BCG: Update on Billing Guidance Given the shortage of bacillus Calmette-Guerin (BCG), the AUA has been in contact with the Centers for Medicare & Medicaid Services (CMS) to get instructions on reporting the vial splitting of BCG for Medicare reimbursement. CMS has provided us with one set of instructions and advised us to verify reporting with each of the Medicare Administrative ...
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The Centers for Medicare & Medicaid Services (CMS) recently released the 2017 Quality Payment Program (QPP) Experience Report with Appendix . In 2017 CMS launched the QPP. This new effort geared toward a value-based system of care is divided into two participation tracks: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Given the requirements of these two options, most urologists were required to participate via MIPS. Therefore the AUA has used its resources to help members with this program. The new Experience Report and Appendix provide a comprehensive overview of the clinician reporting experience during the ...
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The AUA Coding and Reimbursement Committee (CRC) reviewed a request for the appropriate coding for utilizing a penile pressure cuff and supports the use of CPT code 51741 Complex uroflowmetry (e.g., calibrated electronic equipment) and CPT code 51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique when the uroflow and EMG are performed and documented.  However, the CRC determined that 51728 Complex cystometrogram (i.e., calibrated electronic equipment with voiding pressure studies (i.e., bladder voiding pressure), any technique with modifier 52 Reduced Services is not appropriate to report the voiding ...
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The Food and Drug Administration (FDA) announced that Ata Int. Inc. is voluntarily recalling BLUEFUSION , a supplement promoted for sexual enhancement, because an FDA laboratory analysis found the supplement contains undeclared sildenafil, tadalifil, desmethyl carbodenafil, dithiodesmethyl carbodenafil, scutellarin and daidzein. The presence of the undeclared active ingredients renders the product an unapproved drug for which safety and efficacy has not been established and, therefore, subject to recall. Sildenafil and tadalafil are FDA-approved drugs for the treatment of male erectile dysfunction and are in a class of drugs called phosphodiesterase ...
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As part of its educational efforts through the Learning Management System , the Centers for Medicare & Medicaid Services (CMS) is now offering a free, online course: Using Your 2017 Merit-based Incentive Payment System (MIPS) Performance Feedback . Performance reports detail how successfully a practice and/or provider participated in the program and highlight areas for improvement. It is important that those who participate in MIPS know how to read the reports to ensure that CMS is tallying one’s score correctly. If CMS is not, one is likely being financially penalized, and misinformation is being presented to the public as the data available in ...
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The latest AUA Guidelines will be released at the Annual Meeting in May. New guidelines being introduced include: Recurrent Urinary Tract Infection Testicular Cancer Incontinence after Prostate Treatment In addition, new amendments will be released for the AUA’s Overactive Bladder, Surgical Management of Benign Prostatic Hyperplasia (BPH), and Radiation After Prostatectomy guidelines. Instructional sessions will be available at the Annual Meeting to review these new guidelines. A series of Second Opinion Cases: Ask the Guidelines sessions will also be available to provide further information through case studies. The Guidelines At A Glance compendium ...
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BCBS Federal Employee Plan Prostatic Urethral Lift: Blue Cross Blue Shield Federal Employee Health Plan has revised its Prostatic Urethral Lift medical policy with the following changes: Removed criterion stating that member is an appropriate candidate for a surgical procedure using general anesthesia, such as transurethral resection of the prostate, due to a chronic medical condition including but not limited to cardiopulmonary disease or chronic anticoagulation therapy. Updated criterion to clarify that member has persistent or progressive lower urinary tract symptoms “despite medical therapy.” Added an objective section to state that the objective ...
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This week’s update includes information on our joint advocacy efforts to preserve funding for the Patient Centered Outcomes Research Institute and Congressionally Directed Medical Research Programs. Patient & Research Advocacy Update: PCORI and Research Funding Meetings on Capitol Hill On March 18, the AUA attended a Patient Centered Outcomes Research Institute (PCORI) physician stakeholder meeting to discuss the formulation of legislation to reauthorize funding for PCORI. Staff from Sens. Shelley Moore Capito (R-WV), Bill Cassidy, MD (R-LA), Chris Van Hollen (D-MD), and Mark Warner’s (D-VA) offices led the meeting. Partner organizations in attendance ...
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