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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes an updated Prior Authorization (PA) form for Xtandi from BCBS Florida, revisions to the Xeomin medical policy from Caresource, and a new policy concerning urological supplies from BCBS North Dakota. Also, AmeriHealth Caritas VIP Care Plus has published revisions to its Enhanced Cystoscopy for Bladder cancer medical policy, and BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, and HCSC have updated their policies on GnRH Agonists and Antagonists. Also, Dean Health Plan and Prevea360 has updated its medical policy ...
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This week’s update includes information on the AUA’s meeting with more than 35 state legislators and staff to discuss AUA’s state advocacy priorities. State Advocacy Update: NCSL Legislative Summit 2019 Last week, the AUA attended the 2019 National Conference of State Legislatures (NCSL) in Nashville, Tennessee. The AUA had a booth in the exhibit hall, where state legislators, legislative staff, and others interested in public policy could stop by to learn about the AUA and discuss state policies relating to urology. Highlights of the conference include: The AUA held discussions with more than 35 legislators and staff regarding our model legislation ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes updates from AmeriHealth regarding its Erectile Dysfunction (ED) medical policy, revisions to the California Health and Wellness Gender Reassignment Surgery policy, and updates to the Hawaii Medical Services Association’s policy on Incontinence Supplies. Also, Nebraska Blue Cross has published revisions to its Electrical Stimulation of Muscles and Nerves medical policy, Neighborhood Health Plan of Rhode Island has added Xgeva to the policy to their Prolia pharmacy policy, Regence Blue Cross has provided updates to its Sacral Nerve Neuromodulation/Stimulation ...
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This week’s update includes information on the 2020 Medicare Physician Fee Schedule proposed rule and our state advocacy in California to support prostate cancer awareness. 2020 Medicare Physician Fee Schedule: CMS Releases Proposed Rule Following the Centers for Medicare and Medicaid Services’ (CMS) release of the Calendar Year 2020 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule on July 29, the AUA developed an  easy reference on how the proposed rule could impact urology offices. Read more about the fee schedule and view our charts showing the impact of the 2020 Medicare Physician Fee Schedule on some of the most ...
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The Centers for Medicare & Medicaid Services (CMS) August 2 Clinician Outreach Meeting focused on the impending August 12 deadline for Burden Reduction Request for Information (RFI) comments and the upcoming Data at the Point of Care Pilot. There also was discussion concerning the Acupuncture Proposed Coverage with Evidence Development decision, ESRD Treatment Choices (ETC), Voluntary Kidney Models, and the Radiation Oncology Model. The agency is also publicly reporting a subset of the 2017 Quality Payment Program (Year 1) performance information submitted under the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). ...
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The Centers for Medicare & Medicaid Services (CMS) has added new 2017 Quality Payment Program (QPP) performance information to Physician Compare , a website created to allow Medicare patients and caregivers to easily search for and compare clinicians and groups who are enrolled in Medicare. The overarching goals of Physician Compare are to help people with Medicare make informed healthcare decisions and to incentivize clinicians and groups to maximize their performance. Specifically, the 2017 QPP performance information recently posted on Physician Compare primarily includes data related to Merit-based Incentive Payment System (MIPS) eligible clinicians ...
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The Food and Drug Administration (FDA) announced several supplements promoted for sexual enhancement have been found to contain sildenafil, an undeclared active ingredient. The presence of the undeclared active ingredient renders the products unapproved drugs for which safety and efficacy has not been established and, therefore, subject to recall. The concerned products include: Big Penis Black Storm Boss Lion 9000 De Guo Heijin Gang Herb Viagra La Pepa Negra Odimafo Powerful Tablet 200 mg Plant Viagra Shengjingpian Vigour 800 mg FDA laboratory analyses found that all of these supplements contain sildenafil, ...
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Patients are concerned about healthcare costs.  While at one time it was nearly taboo for patients to ask about these costs, it is becoming more common.  However, many clinicians, medical staffs, and health systems cannot answer these questions.  Additionally, patients are not sure of the right person to ask. Right Question, Wrong Person: A Toolkit to Facilitate Cost-of-Care Questions in Health Systems hopes to help with these dilemmas. Supported by a Robert Wood Johnson Foundation mini-grant administered by America’s Essential Hospitals and Essential Hospitals Institute and through the assistance of the ABIM Foundation, Right Question, Wrong Person ...
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Aetna Prostate Cancer Screening: Aetna has made the following changes to criteria and supporting information: Increased age at which prostate-specific antigen (PSA) screening is considered a medically necessary preventive service for men who are considered average-risk for prostate cancer from 40 years of age and older to 45 years of age and older, Increased age at which prostate-specific antigen (PSA) screening is considered a medically necessary preventive service for men who are considered at high-risk for prostate cancer from under 40 years of age to 40 years of age and older, Added note stating that routine prostate cancer screening for ...
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This week’s update, which includes information on advancement of the USPSTF Transparency and Accountability Act, the AUA/Alliance of Specialty Medicine’s concerns with the Prescription Drug Pricing Reduction Act, and release of the 2020 Medicare Physician Fee Schedule and Hospital Outpatient/Ambulatory Surgical Center Payment System proposed rules. Payment Policy: CMS releases 2020 Proposed Rules for MPFS and OPPS/ASC On July 29, the  Centers for Medicare & Medicaid Services issues the proposed rules for the 2020 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient (OPPS)/Ambulatory Surgical Center (ASC) Payment System. The AUA is actively ...
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On July 29, the Centers for Medicare & Medicaid Services (CMS) released the proposed rules for the 2020 Medicare Physician Fee Schedule (which includes updates to the Quality Payment Program, Open Payments program and other Medicare Part B policies) and the Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System. The AUA actively is reviewing both rules, but there are a few important proposed changes in the proposed fee schedule of which urologists should be aware. More detailed analysis of these changes – and more details on how the proposed rules will affect urology – is forthcoming. 2020 Proposed Conversion ...
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Each week the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes important information regarding Xtandi, prostatic urethral lift, posterior tibial nerve stimulation, assistant surgeon payments , brachytherapy, and telemedicine services. Amerigroup Xtandi: Amerigroup has updated its pharmacy policy for Xtandi with the following changes: Updated criteria to add requirement for individual to be concomitantly receiving a gonadotropin-releasing hormone (GnRH) analog or has had a bilateral orchiectomy. Read the complete policy.   Blue Cross Blue Shield Rhode Island Urethral ...
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This week’s update, which includes information on the AUA’s participation in the Alliance of Specialty Medicine’s fly in and the AUA Veteran Affairs Workgroup’s meeting with the ranking member of the House Veterans’ Affairs Subcommittee on Health and the House Veterans’ Affairs Committee Staff Director for Health. Alliance of Specialty Medicine Fly In: 155 Meetings Covering 33 States Almost a dozen members of the AUA’s Legislative Affairs Committee (LAC), Regulatory Workgroup, and Quality Improvement and Patient Safety Committee joined the Alliance of Specialty Medicine to advocate on Capitol Hill on July 16-17. The AUA delegation met with Senators, Representatives, ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes important information regarding Benign Prostatic Hypertrophy (BPH) Treatment, telemedicine, biofeedback for urinary diagnoses, and surgery services. Health Alliance Plan of Michigan Benign Prostatic Hypertrophy Treatments: Health Alliance Plan of Michigan has revised and reviewed the Benign Prostatic Hypertrophy Treatment (BPH) medical policy with the following changes to its criteria and coding: Added the following not covered procedures for HAP/AHL Members as they are considered experimental, investigational or unproven ...
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On July 17, 2019, the Food and Drug Administration (FDA) announced its approval of the antibacterial drug product Recarbrio for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) in adults. Recarbrio received Priority Review by the FDA as part of the Generating Antibiotic Incentives Now (GAIN) title of the FDA Safety and Innovation Act. The overarching goal of the FDA is to address the threat of antimicrobial-resistant infections by facilitating the development of safe and effective new treatments to give patients more options to fight serious infections. Recarbrio is a three-drug combination injection ...
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This week's update includes information on more than a dozen meetings with congressional offices gathering support for the USPSTF Transparency & Accountability Act, patient and research advocacy news and our support of H.R. 3107, the Improving Seniors' Timely Access to Care Act.We are also excited this week to launch our first Advocacy Update episode of the AUA's Inside Tract podcast . U.S. Election News: North Carolina Urologist Greg Murphy Advances to General Election! Congratulations to AUA member Dr. Greg Murphy for his win on July 9 in North Carolina's special primary election for the open seat to represent the state's 3rd District in the U.S. ...
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The AUA continues to follow surprise medical billing (SMB) issues closely. Assemblymember David Chiu (D) introduced AB 1611 that would limit the cost-sharing required of a patient receiving covered emergency services at a hospital that does not have a contract with the patient’s health plan, insurer, or other third-party payor to no more than the same cost-sharing that the patient would pay for the same covered emergency services received from a contracting hospital. AB 1611 would establish, as the rate of payment for those services, the reasonable and customary value of the hospital services or the average contracted rate for the same or similar hospital services ...
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On July 9, the Accessible Care by Curbing Excessive Lawsuits (ACCESS) Act , H.R. 3656, was introduced by Reps. Richard Hudson (R-NC-8), Roger Marshall, MD (R-KS-1), and Larry Buschon, MD (R-IN-8). If passed, the bill would reform medical liability laws by: Providing full compensation of medical and economic damages and up to an addition $250,000 in noneconomic damages; Maximizing the amount of any award that goes to injured patients by limiting attorney contingency fees; Resolving claims quickly with a reasonable statute of limitations; Preventing double recovery by accounting for evidence of collateral source benefits paid; Encouraging physicians ...
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The purpose of patient relationship categories and codes is to facilitate the attribution of patients and care episodes to clinicians who serve patients in different roles as part of the assessment of the cost of care. There have been many questions on the use of the Modifiers X1-X5 to report patient relationships. Specifically, how physicians can incorporate them into their practice, as well as more clarification about the voluntary vs. mandatory reporting periods. As indicated in a CMS MLN Matters article, MM11259 it states that the use of the modifiers are voluntary. CMS has a wealth of information on their website relating the use of the modifiers: ...
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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. An FDA laboratory analyses found that Germany Black Gorilla and Peru Maca both contain sildenafil, 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 these supplements, they could ...
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