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This week’s update includes information on the AUA’s Hill meetings with freshman congressional offices to introduce them to our legislative priorities. We also update you on our partnership to stave off any potential threats in fiscal year 2020 funding for the Department of Defense’s Congressionally Directed Medical Research Programs. Please note that the next weekly update will be the week of February 25. BCG Shortage: Update on AUA Outreach The AUA continues to reach out to Merck and the U.S. Food and Drug Administration on the BCG shortage. Last week, AUA representatives had a follow-up call with Merck where it was reiterated that the shortage will ...
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Anthem Blue Cross Evaluation and Management (E/M) Provider Update: Anthem Blue Cross and Blue Shield has issued a letter to providers identifying an issue with providers billing E/M services.  Anthem has identified that  many providers are billing a duplicate E/M service on the same day as a procedure even when the same provider (or a provider with the same specialty within the same group TIN) recently billed a service or procedure that included an E/M for the same or similar diagnosis. The use of modifier 25 to support separate payment of this duplicate service is not consistent with correct coding or Anthem’s policy on the use of modifier 25. Beginning ...
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This month’s Centers for Medicare & Medicaid Services (CMS) Clinician Outreach meeting focused on the new Medicare Card and the launch of the agency’s “What’s Covered app”. New Medicare Card Update The transition period runs through Dec 31, 2019. During this year, Medicare patients can still use their current Health Insurance Claim Number (HICN), which is printed on their card. Practices are encouraged to subscribe through their MAC portals, in order to look up the new Medicare Beneficiary Identifier number (MBI). Patients may call 1-800 Medicare if they have questions. Learn more here. New Medicare “What’s Covered App” CMS has ...
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This week’s update includes information on our Congressional meetings on workforce issues as well as the AUA, Alliance of Specialty Medicine’s response to the administration’s draft  “ Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” We also include insurance updates pertinent to urologic care. Congressional Outreach: AUA Meets with Freshman Offices The AUA began its outreach to freshman offices with the goal of introducing them to issues of concern in urology and how those issues impact patients. On January 28 and 30, the AUA met with staff in the offices of Reps. Michael Waltz (R-FL-6) and Debbie ...
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On December 8, 2018, the AUA hosted the 2018 Quality Improvement Summit : Opioid Stewardship in Urology, provided an opportunity for the urologic community to examine a topic significantly affecting not only urology, but society at large. Due to a grant (R13HS026679) from the Agency for Healthcare Research and Quality (AHRQ), the AUA once again was able to provide travel scholarships to several residents and fellows. The 2018 Quality Improvement Travel Scholars were: Christi Butler, MD; Julia Finkelstein, MD; Elizabeth A. Green, MD; Tim Large, MD, MS; Vikram Madhaven Narayan, MD; Ruchika Talwar, MD; and Anna M. Zampini, MD, MS, MBA. Following up on ...
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The AUA Board of Directors recently updated two AUA position statements to include updated guidance and to more accurately reflect current terminology. The AUA’s HPV Vaccination for Males and Females has been revised to align with new guidance issued by the Food and Drug Administration that extends the use of Gardisil to age 45 (October 2018). Previously, evidence only addressed children and adults under the age of 27. Additionally, the AUA’s Position Statement: Opioid Use has been revised to incorporate current terminology in the field of substance use disorders
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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 undeclared sildenafil and tadalafil.  Rhino 5k Silver Bullet   Sildenafil and tadalafil are FDA-approved pharmaceutical ingredients 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 product can interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. ...
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On January 8, 2019, the AUA hosted a Merit-based Incentive Payment System (MIPS) webinar featuring the Centers for Medicare & Medicaid Services (CMS) subject matter specialists Barbara J. Connors, DO, MPH and Patrick M. Hamilton, MPA. A recording of the webinar as well as the slides are available on the AUA’s website. During the 90-minute webinar, Dr. Connors and Mr. Hamilton reviewed the basics of 2018 MIPS, discussed reporting details for 2018, highlighted changes to the 2019 MIPS program, and answered participant questions. The webinar and slides are part of the AUA’s MIPS toolkit , a compilation of resources to help AUA members participate in ...
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The AUA is excited to announce the return of our yearly content series, PMC Highlights. This series will provide our members with a preview of the impactful presentations and events they can expect at the 2019 AUA Practice Management Conference in Chicago. This year, our series begins with two of our speakers: Dr. Neil Baum and AUA coding expert Edna Maldonado. Dr. Baum will deliver his presentation "Improving Medication Compliance in Urologic Practices" to our conference attendees on May 2. Dr. Neil Baum is an associate clinical professor of urology at Tulane Medical School and Louisiana State University Medical School, both in New Orleans. He is also ...
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Each year the Merit-based Incentive Payment System (MIPS) becomes a little more complicated and the payment adjustment threshold increases as well. In 2019, a participant must now have an overall score of at least 30 points to avoid the penalty, and that penalty can be up to 7 percent of one’s Medicare Part B payments in calendar year 2021. The best way to achieve a score of 30 points and perhaps earn a bonus is to plan early. The Centers for Medicare & Medicaid Services (CMS) has created benefits specifically for solo providers and members of small practices (defined as fewer than 15 providers). If your practice meets these requirements, take advantage ...
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BCBS North Dakota Biofeedback: Blue Cross Blue Shield of North Dakota has revised its Biofeedback medical policy with the following revisions: Added statement that biofeedback may be considered medically necessary for the treatment of stress and/or urge incontinence in cognitively intact members who have failed a documented trial of pelvic muscle exercise training to the policy/criteria section. Removed investigational statement for the use of biofeedback for the treatment of constipation in adults and children in all situations from the policy/criteria section. Removed investigational statement for the use of biofeedback for the treatment of fecal ...
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This week’s update includes information about the USPSTF Transparency and Accountability Act and two state advocacy activities: Indiana’s scope of practice measure and New York’s fertility coverage legislation. USPSTF Reform: Update on Bill Efforts and Plan for New Congress Starting in November of last year, the AUA began working with its partners at LUGPA, Men's Health Network, ZERO – The End of Prostate Cancer, and new partners from breast and cervical cancer groups on an updated version of the USPSTF Transparency and Accountability Act. It still incorporates the need for specialty input and the expert panel that the AUA has been advocating for over ...
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BCBS North Carolina Agents for Prostate Cancer (Xtandi, Zytiga, and Yonsa) PA Criteria: Blue Cross Blue Shield of North Carolina has revised its Agents for Prostate Cancer prior authorization policy with the following changes: Expanded indication for Xtandi. Added to criterion stating that members new to Xtandi therapy are required to have trial and failure, intolerance, or contraindication to Zytiga. Removed specification from criterion regarding diagnosis that indication castration-resistant prostate cancer must be metastatic. Added that approval duration for quantity limit exception is 365 days. Read the complete policy. Excellus ...
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This week’s update includes news on our meeting with Senator Bill Cassidy’s office as well as a briefing with Congressional members promoting reauthorization of funding for the Patient-Centered Outcomes Research Institute in 2019. Congressional Outreach: AUA Holds Policy Meeting with Senator Cassidy’s Office On January 17, the AUA met with the office of Sen. Bill Cassidy, MD (R), the senior senator from Louisiana. A strong supporter of the AUA’s issues, Dr. Cassidy is a member of both of the committees that oversee health policy: Health, Education, Labor & Pensions (HELP) and Finance. The meeting served as a way to identify issues that both Dr. Cassidy ...
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Health Alliance Plan of Michigan Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction and Fecal Incontinence and Constipation: Health Alliance Plan of Michigan has revised its Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction medical policy. The company has added posterior tibial nerve stimulation (PTNS) to policy and now, PTNS may be considered medically necessary when criteria are met. The company has also added exclusions of coverage for PTNS, which include, but are not limited to, the following: Urinary indications except overactive bladder (OAB) as those uses are considered experimental, investigational, ...
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As part of our ongoing efforts to monitor drug supply issues, the AUA recently reached out to Merck regarding member concerns about recent changes in availability for bacillus Calmette-Guerin (BCG). Due to increased need globally for BCG and anticipated supply constraints, Merck has announced a shift in the distribution model for its TICE ® BCG product and is in the process of communicating changes with providers and practices. Learn more from the FDA. The AUA will continue to provide updates as information becomes available. Members with questions are urged to contact the Merck National Service Center at 1-800-672-6372
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The first quarter of 2019 straddles the MIPS seasons of both 2018 (Year 2) and 2019 (Year 3) of the program. The 2018 submission period just opened, and participants have until April 2 to send their data to the Centers for Medicare & Medicaid Services (CMS). However, some participants are ready to begin 2019 reporting. For those practices, a synopsis of the differences between the two reporting years is noted and a list of 2019 resources has been compiled. 2018 Data Submission Period Now Open CMS has officially opened the data submission period for MIPS eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program (QPP). Apart ...
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The 2018 Quality Improvement Summit was held at the American Urological Association (AUA) headquarters in Linthicum, MD, on Saturday, December 8, 2018. Nearly 100 attendees participated in the event, which focused on opioid stewardship in urology. Chaired by Drs. Angela Smith of the Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill and Gregory Auffenberg of Northwestern University’s Feinberg School of Medicine, the Summit featured didactic presentations, panels, and question and answer sessions that allowed the audience to share their experiences. Speakers represented various disciplines in order to demonstrate the need ...
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This week’s update includes information on the AUA’s participation in the Alliance of Specialty Medicine’s meeting with the Centers for Medicare & Medicaid Services to address challenges with Medicare Advantage, as well as our meeting with Representative Jackie Walorski on workforce issues. Congressional Outreach: AUA Meets with House Ways & Means Member On January 9, the AUA met with Rep. Jackie Walorski (R-IN-2) during a meet and greet sponsored by the Alliance of Specialty Medicine. Congresswoman Walorski serves on the House Ways & Means Committee, which is one of the two House committees with jurisdiction on health policy. During the meeting, ...
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BCBS Arkansas Hormone Pellet Implantation for Hormone Replacement Therapy: Blue Cross Blue Shield Arkansas has revised its hormone replacement therapy coverage policy for females. The company is changing implantable hormone pellets from meeting member coverage criteria to not meeting coverage criteria or being considered investigational. Preauthorization is now required.  BCBS AR states that implantable hormone pellets (testosterone and/or estrogen) do not meet member benefit certificate primary coverage criteria, and requires that there be scientific evidence of effectiveness for females, as a method of hormone replacement therapy (HRT). The company ...
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