Blogs

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Florida reviewed its Temporary Prostatic Stent and Prostatic Urethral Lift Policies. Additionally, Blue Shield California reviewed its Brachytherapy for Clinical Localized Prostate Using Permanently Implanted Seeds Policy. Please see below for further information about each update. COVID-19 Updates Independence Blue Cross Telemedicine Services Policy:  Independence Blue Cross reviewed ...
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On October 9, the AUA signed an E/M Coalition letter urging House and Senate leaders to pass H.R. 8505, a bill that would prevent pending Medicare payment cuts by waiving the budget neutrality requirements for the finalized evaluation and management (E/M) code proposal slated for implementation on January 1, 2021. The letter reminds Congress that, by adhering to existing budget neutrality requirements for implementing the new policy, sizable cuts will be generated for various sections of the provider community.    As a reminder, since the onset of the pandemic, the AUA has consistently advocated that Congress suspend budget neutrality requirements for the ...
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On October 8, the AUA joined other member groups in signing a Surprise Medical Billing Coalition physician community statement urging Congress not to enact surprise billing legislation that:   further destabilizes physician practices and jeopardizes access to care; exacerbates disruptions in our health care system; or favors an insurance industry that is setting all-time record profits. The Senate and House are both considering legislation to address surprise medical bills that patients may incur as a result of unexpected gaps in insurance coverage or medical emergencies. Recently, the physician community became aware of congressional discussions ...
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On October 5, the AUA attended the Friends of National Institute of Digestive and Diabetes and Kidney Disease’s (FoNIDDK) virtual briefing, “NIDDK: Addressing Racial & Ethnic Disparities in Research.” The briefing was attended by 142 participants, including 90 congressional offices. The panel featured opening remarks from Representative Donald Payne Jr. (D-NJ-10), who highlighted his personal perspective as a dialysis patient and the critical need to improve health disparities, especially during the COVID-19 pandemic. NIDDK Director Dr. Griffin Rogers presented specific programs and research taking place at NIDDK that address racial and ethnic disparities. ...
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On October 6 and 8, the AUA/UCF hosted the 7 th  Annual Bladder Health Alliance virtual roundtable meeting. The program convened more than 75 participants representing 38 patient, physician, and research advocacy organizations. The event included an extraordinary panel of presenters who highlighted bladder health research taking place at the National Institutes of Health (NIH). Panelists, representing the National Institute on Aging, National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, and the National Institute of Nursing Research, ...
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Raymond Wezik, JD, joined the AUA October 19 as the new Director of Policy & Advocacy. Ray comes to the AUA from the International Myeloma Foundation; in his previous position as Director of Public Policy & Advocacy he developed and implemented strategic advocacy plans on issues such as value-based drug pricing models, problems associated with out-of-pocket cost increases, and rural healthcare access. He also directed the Veterans Against Myeloma Program and worked to support the Congressionally Directed Medical Research Programs Peer Reviewed Cancer Research Program. In addition, he launched the All Cancers Congress (to which the AUA belongs) ...
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On October 14, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the COVID-19 public health emergency (PHE). For the first time using a new expedited process, CMS is adding 11 new services to the Medicare telehealth services list since the publication of the May 1 COVID-19 Interim Final Rule. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. Medicare will begin paying practitioners who furnish these newly added telehealth services effective immediately, and for the duration ...
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On October 13 and 14, the AUA met with staff in the offices of Senators Kelly Loeffler (R-GA) and Richard Blumenthal (D-CT) – both of whom are members of the Senate Veterans’ Affairs Committee. The meeting was regarding the aforementioned H.R. 6092. The AUA’s strategy is to continue to identify bill champions in the other chamber and work to develop a pathway for passage before the 116th Congress adjourns at the end of the year. In an effort to help this important legislation move forward, please log onto the AUA’s  grassroots alert system  and urge your lawmaker to cosponsor H.R. 6092. The AUA will continue to keep you updated on this legislation as it ...
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The AUA successfully corrected an incorrect edit on within the National Correct Coding Initiative (NCCI) procedure-to-procedure and Medically Unlikely Edits edit files. The incorrect edit was the performance of a diagnostic ureteroscopy (CPT 52351) on the contralateral side during the performance of a ureteroscopy with laser lithotripsy and stent (CPT 52356).  After identifying the incorrect edit, AUA Coding and Reimbursement Committee Chair Dr. Jonathan Rubenstein spoke with the contractor to explain the procedure and why the NCCI edit was erroneous. For example, if a patient is found on imaging to have a stone in both the left and right ureter, a CPT 52356 ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Mississippi reviewed its Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds, Genetic Testing, and Prostatic Urethral Lift Policies. Additionally, Aetna reviewed its Urological Supplies Policy. Please see below for further information about each update. COVID-19 Updates Anthem COVID-19 News (Connecticut) News & Announcements: Anthem (Connecticut) updated ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Illinois, Montana, New Mexico, Oklahoma and Texas reviewed their Temporary Prostatic Stent Policies. Additionally, Palmetto reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease Local Coverage Article (LCA). Please see below for further information about each update. COVID-19 Updates AmeriHealth Lab Management Codes (eviCore) Document: AmeriHealth reviewed its Lab Management ...
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On September 30, Congress overwhelmingly gave final approval and President Trump signed into law H.R. 8337 , a measure that would extend current levels of federal funding through December 11 that avoids a government shutdown just before the November election. The bill extends the Medicare geographic practice cost index (GPCI) floor and a number of health care programs, including community health centers, the National Health Services Corps that were set to expire on November 30. The bill also averts a $50 increase in 2021 Medicare Part B premiums. It would instead limit any increase in Medicare premiums to approximately $4 a month. Pressure continues to mount ...
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On October 1, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) announced $20 million in new funding through the CARES Act Provider Relief Fund. Providers can apply for the new funds starting October 5. According to a statement from HHS, the new Phase 3 General Distribution “is designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.” Providers eligible for relief under the Phase 3 General Distribution include: Providers who previously received, ...
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On September 17, AUA leadership met virtually with the Centers for Medicare & Medicaid Services’ Hospital and Ambulatory Policy Group Division of Practitioner Services in advance of submitting final comments on the proposed Calendar Year 2021 Medicare Physician Fee schedule.  The discussion focused on proposed policies for telehealth, evaluation and management (E/M) services, burden reduction, and valuation of specific urology services. Urology Telehealth Taskforce Chair Aaron Spitz, MD, opened the meeting by thanking the agency for the flexibilities that have been made in response to the COVID-19 pandemic and for proposing to make additional changes to ...
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The White House released its latest executive order (EO) on drug pricing on September 13 that would ensure that Medicare pay no more than the lowest price for a drug than it is sold for in any Organisation for Economic Co-operation and Development (OECD) country with a comparable per capita GDP. The EO directs the U.S. Department of Health and Human Services to immediately begin a demonstration project to test the “most favored nation” approach under Medicare Part B. A similar model would be implemented for Medicare Part D for those products without competition for which patients pay prices higher than in comparable OECD nations. The President had previewed ...
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In an effort to standardize provider-to-provider documentation exchanges, the Centers for Medicare & Medicaid Services (CMS) encourages providers to participate in an interoperability pilot to test medical documentation exchanges. The   Electronic Medical Documentation Interoperability (EMDI) Initiative   is designed to reduce provider burden by helping providers standardize their workflow, so they can send and receive documentation electronically by: Implementing interoperable workflows Providing educational sessions and workgroups Connecting you to collaboration with other providers Creating resources Supporting CMS policies, regulations, ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Louisiana and Blue Cross Idaho reviewed their Prostatic Urethral Lift Policies. Additionally, Aetna reviewed its Urinary Incontinence Policy. Please see below for further information about each update. COVID-19 Updates 1199SEIU Funds Lab Management Code List (eviCore) Coding Document: 1199SEIU Funds reviewed its Lab Management Code List adding the following CPT codes: U0003 – Infectious agent detection ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Rhode Island reviewed its Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence Policy and Horizon BCBS New Jersey reviewed its Prostatic Urethral Lift Policy. Additionally, Aetna reviewed its Prostate Saturation Biopsy Policy. Please see below for further information about each update. COVID-19 Updates Multiple Insurers Multiple insurers released policy updates related to In-Vitro ...
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The AUA is pleased to announce that  H.R. 6092 , the Veteran’s Prostate Cancer Treatment and Research Act, unanimously passed the House of Representatives on September 22. The AUA worked closely with House lawmakers to develop and advance this important piece of bipartisan legislation, which was introduced earlier this year by Rep. Neal Dunn, MD (R-FL-2), a urologist, and Rep. Joe Cunningham (D-SC-1). The AUA is already working to identify a champion in the U.S. Senate, where we are confident the bill will be introduced. The Veteran’s Prostate Cancer Treatment and Research Act would establish a national clinical pathway for prostate cancer, a comprehensive ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Illinois, Montana, New Mexico, Oklahoma and Texas reviewed their Nerve Graft with Radical Prostatectomy Policy. Additionally, BlueAdvantage Administrators of Arkansas reviewed its Intensity-Modulated Radiotherapy of the Prostate Policy. Please see below for further information about each update. COVID-19 Updates Aetna OfficeLink Updates Newsletter News & Announcements: Aetna published its provider ...
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