Blogs

On January 9-11 the American Urological Association (AUA) attended the American Medical Association’s (AMA) State Advocacy Summit in Bonita Springs, Fl. The AUA sponsored two physicians at this year's summit - Dr. Arthur Tarantino (AUA State Advocacy Committee Chair-elect) of Connecticut and Dr. William Reha (AUA State Advocacy Committee Member) of Virginia.The sessions at the summit focused on national and local health policy trends that are expected during the 2020 legislative year and also touched on successful past advocacy efforts. Below are a few session highlights and trends: Prior Authorization Reform and Strategy . A panel discussed the most impactful ...
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Eligible clinicians who participated in the 2019 Merit-based Incentive Payment System (MIPS) program can now submit their data to the Centers for Medicare & Medicaid Services (CMS). Data can be submitted and/or updated until 8:00 p.m. EDT on Tuesday, March 31, 2020. Those that opted to report Quality measures via Medicare Part B claims have already submitted data for this category throughout the 2019 performance period. These participants may now sign in to qpp.cms.gov to access preliminary feedback on their Part B claims measure data processed to date. CMS will update this feedback at the end of the submission period with claims processed by the Medicare ...
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The Food and Drug Administration (FDA) announced several supplements promoted for sexual enhancement have been found to contain an undeclared active ingredient. The presence of undeclared active ingredients renders the products unapproved drugs for which safety and efficacy has not been established and, therefore, subject to recall. Motto International Corp., the manufacturer of all the concerned products, is voluntarily recalling the items. The products include: Bull Platinum 30000 Panther Platinum 30000 Rhino 7 Platinum 30000 Stallion Platinum 30000 All four supplements were found to contain tadalafil, an FDA approved drug for the treatment of ...
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Have questions regarding Merit-based Incentive Payment System (MIPS) reporting for 2020? The AUA will host a free webinar featuring experts from the Centers for Medicare & Medicaid Services (CMS), who will explain changes to the program and answer questions. The webinar on Tuesday, March 10, 2020, at 1:00 p.m. Eastern is exclusive to AUA and PMN members. Register now by emailing Quality@AUAnet.org. The minimum reporting score in 2020 will be 45 points, meaning those that fall below that number will be penalized to some extent, and anyone who does not report will incur the full payment adjustment (penalty) of 9 percent. However, there is also the potential ...
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Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes changes to prior authorization requirements from Aetna, CGS Administrators, ConnectiCare and Express Scripts. Also, First Coast Service Options (FSCO) published Local Coverage Articles (LCAs) with updated coding information to accompany the Biofeedback, Botox, Posterior Tibial Nerve Stimulation (PTNS), and Prostatic Urethral Lift (PUL) Local Coverage Determinations (LCDs). Furthermore, Noridian provided updated coding information for its Circulating Tumor Cell Marker Assays medical policy, and UnitedHealthCare (UHC) revised prior authorization ...
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On January 8, 2020, the Food and Drug Administration approved Keytruda (pembrolizumab) for the treatment of patients with BCG-unresponsive, high-risk, non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.                           The recommended pembrolizumab dose is 200 mg every 3 weeks. The most common adverse reactions were fatigue, diarrhea, rash, pruritis, musculoskeletal pain, hematuria, cough, arthralgia, nausea, constipation, urinary tract infection, peripheral edema, hypothyroidism, and nasopharyngitis. In a clinical trial, 46% of ...
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At the 2019 Annual Urology Advocacy Summit, more than 240 members of the urologic community engaged lawmakers on a variety of topics affecting urologists and their practices, including the reauthorization of the Patient-Centered Outcomes Research Institute (PCORI). We are pleased to report that Congress reauthorized PCORI for an additional 10 years as part of the appropriations package for 2020 that passed in December 2019. The AUA – together with others in the Friends of PCORI Reauthorization – fought to include the reauthorization as part of the FY2020 Appropriations package, H.R. 1865, which includes a $2.6 billion funding increase for the National Institutes ...
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This week’s update includes information on our comments to address proposed rulemaking from the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG) on the physician self-referral regulations and the anti-kickback statute. In addition, we share news on top state advocacy issues, including SB 201 in California – a bill that aims to ban treatment, including the option for surgery, in young intersex patients. Medicare Physician Fee Schedule (MPFS) Conversion Factor: Alliance Letter on Payment Updates On December 23, 2019, the AUA, together with the Alliance of Specialty Medicine, sent a letter to the chairs of the Senate ...
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The top takeaway from the Centers for Medicare & Medicaid Services (CMS) January Clinician Outreach Meeting focused on the Program Integrity Enhancements to the Provider Enrollment Process Final Rule.   CMS released this rule in September 2019, and it went into effect in November 2019. The agency stated that the rule is designed to keep providers who commit fraud, waste, or abuse out of the Medicare, Medicaid, and the Children’s Health Insurance Plan (CHIP) programs. CMS is confident that this new rule will not create any undue burden on providers who are following all applicable billing regulations. There are several key provisions within the rule, including, ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes Health Now New York’s new medical policy for Transurethral Water Vapor Therapy for Benign Prostatic Hyperplasia, as well as their update for Protein and Genetic Testing for Prostate Cancer. Blue Cross Blue Shield (BCBS) Federal Employee Plan has published updated its pharmacy policy on Erleada, Blue Advantage Administrators of Arkansas provided updates to its Minimally Invasive Benign Prostatic Hyperplasia (BPH) Treatments policy, and BCBS Rhode Island made an important announcement concerning the medical necessity of Transurethral Water ...
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On December 9, the American College of Surgeons (ACS) issued a press release condemning the bipartisan, bicameral surprise billing package released last week by Health, Education, Labor & Pensions Committee Chair Sen. Lamar Alexander (R-TN), , and Energy & Commerce Committee Chair Reps. Frank Pallone (D-NJ-06) and Ranking Member Greg Walden (R-OR-02). While the exact bill language for the package was not released, a section-by-section summary is available. In the statement, ACS expresses its concerns over the $750.00 established as the floor before a physician may seek an independent dispute resolution, and the possible power of rate settings insures ...
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This week’s update includes information on a Washington state bill requiring telemedicine training and this week’s insurance updates. State Advocacy Update: Telemedicine Bill Pre-Filed in Washington State; AUA Meets with the Ambulatory Surgery Center Association On December 10, Senator Randi Becker (R) pre-filed SB 6061, a measure that exempts physicians and osteopathic physicians from being required to complete a telemedicine training service in the state of Washington. SB 6061 has been pre-filed for the 2020 legislative session, which is expected to convene January 14, 2020. Read the full bill. On December 11, the AUA met with the Ambulatory Surgery ...
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Anyone qualified for a Promoting Interoperability Hardship Exception or Extreme and Uncontrollable Circumstances Exception for the 2019 Performance Year of MIPS must submit an application to CMS by Tuesday, December 31, 2019 . Who is Eligible for a Promoting Interoperability Hardship Exception? MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of the Promoting Interoperability performance category to 0 percent if they: Are a small practice (15 or fewer providers); Have decertified electronic health record (EHR) technology; Have insufficient Internet connectivity; Face extreme and uncontrollable circumstances ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes Amerigroup Real Solutions’ update for its Jevtana policy; Cigna’s the update to its the Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction medical policy; HealthNet’s new medical policy for Nubeqa and revisions to the Prostatic Urethral Lift medical policy; and Highmark Blue Cross Blue Shield’s changes to the Services Not Separately Reimbursed policy. Amerigroup Real Solutions Jevtana (cabazitaxel): Amerigroup Real Solutions has reviewed its Jevtana coverage policy with the following changes to criteria: ...
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This week’s update includes information on our latest AUAPAC event and our joint meeting with the Centers for Medicare & Medicaid Services to address payment disparities for CPT code 50590 Lithotripsy, extracorporeal shock wave . We also provide an update on our Congressional meetings to discuss the USPSTF Transparency and Accountability Act , surprise billing, and veterans’ issues. Robert Bass, MD Named 2020 Gallagher Health Policy Scholar Last week, the AUA announced that Dr. Robert Bass had been selected as the 2020 Gallagher Health Policy Scholar. Dr. Bass is the newest participant in this important, year-long program that provides intensive ...
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Payment adequacy and updating payment services were key topics at the December 5, 2019 meeting of the Medicare Payment Advisory Commission (MedPAC). The AUA attended the meeting. Here are highlights: Payment Adequacy for Physicians and Other Professionals MedPAC discussed whether payments to health care professionals are adequate and how they should be updated in 2021. They examined several factors, including beneficiaries’ access to care, quality of care, and Medicare payments and providers’ costs. On the one hand, the following were positive results relative to access to care and payments: No trouble getting appointments Access to care is the ...
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The top takeaway from the Centers for Medicare & Medicaid Services (CMS) December Clinician Outreach Meeting focused on lessons learned from the Transforming Clinical Practices Initiative (TCPI), a practice transformation and quality improvement initiative of the Center for Medicare & Medicaid Innovation (CMMI). During the call, the AUA was mentioned for our successful collaboration with the American College of Emergency Physicians’ on the 2017 AUA QI Summit on Challenges and Opportunities for Stewardship of Urological Imaging.                                                                                                                Lessons ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes Humana’s revised policy for Erleada, Anthem Blue Cross Blue Shield’s revised policy for Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications, United Healthcare (UHC) Community Plan’s revision for the Procedure to Place of Service medical policy, Harvard Pilgrim’s updated commercial medical policy for Cryotherapy for Prostate Cancer, and United Healthcare’s revision of the National Drug Code (NDC) Requirement Policy. Humana Erleada Pharma Policy: Humana reviewed and revised the Erleada pharmacy ...
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On December 5, 2019, representatives from the AUA, LUGPA and AACU met with the Centers for Medicare & Medicaid Services (CMS) Division of Outpatient Care and Hospital & Ambulatory Policy Group. This was the first time all three organizations met with CMS as a unified voice, in this case to discuss the payment disparity for CPT code 50590 Lithotripsy, extracorporeal shock wave also known as ESWL. The meeting came about after many years of changes in outpatient payment assignments in the Ambulatory Payment Classification (APC) for CPT code 50590. The recent change in assignment of ESWL from APC 5375 to 5374 caused a decrease in payment in the outpatient ...
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This week’s update includes news about our comment letter to the House Ways & Means Committee on priority topics that affect health status and outcomes in underserved communities as well as research and state advocacy updates. Urologic Workforce: AUA Sends Comment Letter to House Ways & Means Committee On November 29, the AUA submitted a comment letter in response to the House Ways & Means Committee’s request for information soliciting input on priority topics that affect health status and outcomes in underserved communities. The information collected will be used to inform the bipartisan Rural and Underserved Communities Health Task Force ...
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