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The Medicare Payment Advisory Commission (MedPAC) convened for its regularly scheduled meeting on October 5-6. On day one of the meeting, the Commission resumed discussions on policy alternatives for the Merit-based Incentive Payment System (MIPS). Despite the fact that MIPS has only been in place for one year, MedPAC is calling for its repeal. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the much-maligned sustainable growth rate (SGR) payment formula for Medicare Part B with two payment pathways: MIPS and Advanced Alternative Payment Model (APMs). During the October meeting, MedPAC staffers presented research to show that ...
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MRI-Transrectal ultrasound fusion-guided prostate biopsy is a procedure that uses images from a previously performed multi-parametric MRI (MP-MRI) which are uploaded onto a computer and fused to transrectal ultrasound (TRUS) images which are obtained in real time to guide a prostate biopsy.  Areas of interest that had been previously marked (“targets”) from the MP-MRI can be specifically biopsied.  The AUA Coding and Reimbursement Committee (CRC) reviewed proper coding practices for MRI-fusion prostate biopsy in May 2013, and published the coding recommendations an article in the Policy and Advocacy Brief. This article is being updated due to the concern of ...
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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 hidden ingredients.  Fifty Shades 6000 – sildenafil and tadalafil Grande X 5800 – sildenafil and tadalafil Pap Zen 3300 – sildenafil and tadalafil Vegetable Vigra – sildenafil All of these supplements contain active ingredients used in FDA-approved prescription drugs 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 ...
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The Centers for Medicare & Medicaid Services (CMS) recently announced that both the 2016 Physician Quality Reporting System (PQRS) feedback reports and 2016 Annual Quality and Resource Use Reports (QRURs) are now available. These documents contain performance and payment adjustment information. CMS notes that the payment adjustments shown in the reports are based on proposals in the 2018 Medicare Physician Fee Schedule Proposed Rule . The proposed changes include: Reducing the automatic downward Value-Based Payment Modifier (Value Modifier) adjustment by half for practices that did not meet the minimum quality reporting requirements. In other words ...
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This week’s update includes information on our Capitol Hill meetings on physician payment reform, the AUA Holtgrewe Fellow’s experience in Senator Bill Cassidy’s Congressional office, and a Congressional Kidney Caucus briefing on research funding. Coalition Activity: Hill Meetings on MACRA Physician Payment Reform In our October 9 Advocacy Snapshot, we informed you that the AUA is participating in a number of Hill meetings with the Alliance of Specialty Medicine to discuss suggested changes to MACRA’s physician payment system. On October 12, the AUA continued this effort by participating in a meeting with the majority staff for the House Energy & Commerce ...
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Top takeaways from the October 6, 2017 Centers for Medicare & Medicaid Services (CMS) Clinician Outreach Meeting focused on Physician Compare 30-Day Preview, Exchange Open Enrollment Dates, 2016 Annual Quality and Resource Use Report (QRUR) Webcast and Physician Quality Reporting System (PQRS) Feedback Reports and Informal Review for Program Year 2016. Physician Compare 30-Day Preview A minimum sample size of 20 patients is required for performance information to be included on Physician Compare. As part of CMS’ phased approach to public reporting, a subset of 2016 group PQRS measures will be reported on profile pages as Star Ratings. Achievable ...
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On October 11, Dr. Deepak Kapoor, Chairman and Chief Executive Officer of Integrated Medical Professionals and Clinical Associate Professor of Urology at Mount Sinai Hospital in Melville, NY, presented a case study on alternative payment model (APM) development during the preconference of the Second Annual MACRA MIPS/APM Summit. During the presentation, Dr. Kapoor shared helpful tips for APM development. He admitted that developing an APM is difficult, time consuming, and resource intensive, but if planning to do so, the following factors should be considered: 1) patient population, 2) disease state, 3) time, 4) outcome and 5) cost. Another important factor ...
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Independence Blue Cross HCPCS Update: Magnetic Resonance Imaging (MRI)--Guided Focused Ultrasound Ablation has been updated to add the following HCPCS Level II Code Number: C9747 - Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance. While they have added this HCPCS code, the policy still lists this procedure for ablation of the prostate as investigational.  Read the full policy. .  Modifier 25 Policy: The policy for Modifier 25 has been updated.  In August of 2017 to reduce reimbursement of services, and will now start paying 50 percent of evaluation and management (E/M) when submitted ...
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This week’s update includes information on the AUA’s Capitol Hill meetings on physician payment reform and U.S. Preventive Services Task Force reform, insurance updates on prior authorization and testosterone pellet coverage, and our bladder health awareness initiatives. Physician Payment: Hill Meetings on MACRA, MedPAC Urges Repeal of Merit-based Incentive Payment System Over the next few weeks, the AUA is joining our Alliance of Specialty Medicine colleagues in meeting with Congressional offices to discuss suggested changes to MACRA’s physician payment reform. The identified changes would ensure clinicians have sufficient time and ability to digest, ...
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United HealthCare Update Prior Authorization: Effective Jan 1, 2018, All Savers members will require prior authorization for injectable outpatient chemotherapy drugs given for a cancer diagnosis. Prior authorization will be required for: Chemotherapy injectable drugs (J9000 - J9999), Leucovorin (J0640) and Levoleucovorin (J0641) Chemotherapy injectable drugs that have a Q code Chemotherapy injectable drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code All outpatient injectable chemotherapy drugs started after the chemotherapy prior authorization ...
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Recently, the AUA convened key stakeholders for the Centers for Medicare & Medicaid Services (CMS) Spotlight Series meeting at the agency’s headquarters. AUA Chair of Science and Quality Dr. J. Stuart Wolf, Jr. and AUA Chair of Public Policy Dr. Christopher Gonzalez led the meeting which focused on developing alternatives to the two recent measures on non-recommended PSA-based screening.  Participants included representatives from the American Academy of Family Physicians, American Cancer Society, American College of Physicians, American Geriatrics Society, American Society for Radiation Oncology, American Society of Clinical Oncology, Society of Urologic Oncology, ...
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On September 26-27, the AUA participated in the 2018 Public Affairs Council's State and Local Advocacy Conference. Nearly 200 individuals that work in state government relations across a variety of issue areas attended the conference, which was held in our nation’s capital. Topics of particular interest included best practices in state legislative lobbying, political communications strategies, and an overview of the 2018 election cycle for state races. Electoral expert and founder of the Cook Political Report Charlie Cook discussed the possibility of a “wave election year” for Democrats in state races. The upcoming state elections are especially significant as ...
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This week’s update includes information on legislation for increased transparency in local insurance coverage decisions, the AUA’s partnership with patient advocates to support research appropriations funding and upcoming revisions to guidance on compounding drugs. The AUA also has opened a public comment period on two new measures related to shared decision-making and prostate-specific antigen (PSA) screening. Welcome to new Public Policy Council members Drs. R. Jonathan Henderson, Kevin R. Loughlin and Kevin J. Barlog. Our thanks to outgoing members Drs. Martin Dineen, Jeffrey Frankel and Charles McWilliams. Local Coverage Determination: AUA Endorses Clarification ...
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The American Medical Association has announced two new webinar events for providers: Thriving Under MIPS – Where to start? Breaking down the complexity of MIPS Wednesday, October 18, 2017, 1:00 p.m. to 2:00 p.m. ET With many feeling overwhelmed by the complexity of the Quality Payment Program (QPP), physicians struggle to answer one key question – Where do I start? To help assuage this issue, the AMA has released a new customizable resource – the MIPS Action Plan – that breaks down the complexity of the Merit-based Incentive Payment System (MIPS) track of QPP into specific actionable steps. In this 1-hour webinar, attendees will learn ...
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CMS Updates HCPCS Drug/Biological Code Changes - October 2017 Update CR10234 Drug / Biological Code Changes MLN Matters Number: MedLearn Matters (MM) 10234 The October 2017 HCPCS file includes a new HCPCS modifier. Change Request (CR) 10234 informs MACs about the new modifier, ZC, Merck/Samsung Bioepis. The ZC modifier will become effective for claims submitted beginning October 1, 2017, and applies retroactively to dates of service on or after July 24, 2017. MACs shall add the following modifier to the required modifiers that must be used when HCPCS code Q5102 is billed on a claim: HCPCS Modifier: ZC • Short Description: Merck/Samsung ...
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This week’s update, which includes information on our Congressional advocacy on regulatory reform, access to prostate cancer screening, and appropriations funding, as well as an update on the American Medical Association’s report on disorders of sex development. Congressional Black Caucus: AUA Attends Annual Legislative Conference On September 21-22, the AUA attended the Congressional Black Caucus’ 47th 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, especially for higher at-risk ...
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This week’s updates come from CMS and Wisconsin Physician’s Services. Changes to the Medicare Payments for Prostate HIFU Ablation Procedure Centers for Medicare and Medicaid Services has announced a new procedure requiring the insertion of a device as stated in MLN Matters MM10259.  Since January 1, 2017, in both the hospital outpatient prospective payment system and ASC settings, all new procedures requiring the insertion of an implantable medical device will be assigned a default device offset percentage of at least 41%, and thereby assigned device intensive status, until claims data is available. In certain rare instances, the Centers for Medicare ...
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The AUA Annual Census is a specialty representative survey conducted annually to collect and disseminate urology workforce and practice data on the entire urologic community. The primary goal of the Census is to provide a definitive source of data surrounding the urologic profession and practice; such as providers’ geographic distribution, demographic characteristics, education and training, and patterns of urology practice. The AUA Annual Census collects data from urology professionals throughout the world from multiple angles through one systematically designed survey. The AUA encourages all members of the urologic community to participate in the ...
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On Saturday, October 21, the AUA will host its third Quality Improvement (QI) Summit at the AUA headquarters in Linthicum, MD. The event will focus on stewardship of advanced urologic imaging, and joining the AUA as sponsors are the American College of Emergency Physicians and the American College of Radiology.   The day will feature didactic presentations and panel discussions. However, the strength of previous QI Summits has been the dialogue between speakers and attendees, and this will certainly continue at this year’s event. Attendees have noted previously that the exchange between those in the field and content experts has been enlightening for all and ...
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Participants wishing to participate in the Merit-based Incentive Payment System (MIPS) using the 90-day partial reporting option must start collecting data on or before October 2, the last possible day in 2017 to begin reporting and still meet the minimum number of reporting days. This option is one of three available as part of the MIPS “Pick Your Pace” program.    In addition to partial reporting, there are two other options for reporting in 2017: testing and full submission of data. Testing involves reporting a minimum amount of information (such as one measure for one patient) in order to avoid the payment adjustment for not participating, which in 2017 ...
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