Blogs

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Oxford United Healthcare Eligard PA Criteria: Oxford United Healthcare has revised its prior authorization policy for Eligard. They have added gender dysphoria in adolescents (off-label) as an approved indication for Eligard, or generic leuprolide acetate 1 mg/0.2 mL injection kit, when initial and renewal criteria are met (refer to the policy for details). Oxford has also revised criteria for the use of Eligard in the treatment of prostate cancer, adding criteria for several indications including but not limited to asymptomatic disease, PSA persistence/ recurrence, castration-naive disease, and M0 or M1 castration-resistant disease. They have added ...
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Have questions regarding Merit-based Incentive Payment Program (MIPS) reporting for 2018? The AUA will host a webinar featuring experts from the Centers for Medicare & Medicaid Services (CMS), who will explain the program and answer questions.  The webinar on Tuesday, January 8, 2019, at 1:00 p.m. Eastern is exclusive to AUA and PMN members. Register now at Quality@AUAnet.org. Those who fail to report before the 2018 reporting deadline of March 31, 2019, or do not meet the reporting threshold will incur a 5 percent payment adjustment (penalty).  However, there is also the potential to earn a 5 percent bonus or more.  Learn how to correctly report and what ...
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In addition to the federal elections that took place in November, 36 states held gubernatorial elections, and roughly 80 percent of all state legislative seats were decided. Similarly to what happened on the federal level, Democrats benefitted from increased turnout, which led to several key pickups. Democrats flipped control of Governor’s mansions in seven states, bringing their post-election total to 23 Democratic governors to 27 Republican governors. However, Republicans were able to hold on to a few key races. Of particular interest were the following wins: Tony Evers (D) in Wisconsin Laura Kelly (D) in Kansas JB Prtizker (D) in Illinois Gretchen ...
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This week’s update includes information on congressional advocacy on the preservation of Medicare Part D and ensuring seniors have access to affordable medications, Medicare Part B, and Medicare Affordability.  It also includes announcements on the 2019 Gallagher Health Policy Scholar and our keynote speaker at the Annual Urology Advocacy Summit. Patient and Research Advocacy: Coalition Activity on Capitol Hill and Patient Access Summit On November 28, the AUA participated in meetings with staff from Senators Chris Van Hollen (D-MD) and Ben Cardin (D-MD), and Representatives Andy Harris (R-MD-1), John Sarbanes (D-MD-3) and Anthony Brown (D-MD-4). The ...
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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 ingredients.  American Treasure ( sildenafil) Best Leopard Miracle of Honey ( sildenafil) Gold Max Blue ( sildenafil) Leopard Secret Miracle Honey ( sildenafil) MOB Candy (sildenafil and tadalifil) Willy Go Wild (sildenafil and tadalifil) Sildenafil and tadalifil are FDA-approved pharmaceutical ingredients used to treat erectile dysfunction. While there are no reports of illness associated with the list of ...
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Due to potential confusion and overlap between CPT codes 50395 Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneou s and CPT code 50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation) , the American Medical Association (AMA) CPT Editorial Panel decided that CPT code 50395 should be eliminated and replaced with new codes that describe dilation of a percutaneous endourologic tract large enough to accommodate instrumentation. ...
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Legendary two-time Pulitzer Prize-winning journalist and author, and associate editor of The Washington Post Bob Woodward will deliver the opening keynote address at the 2019 Annual Urology Advocacy Summit. The AUA-hosted event will take place from March 4-6, 2019, on Capitol Hill in the heart of Washington, D.C. Mr. Woodward, is a journalistic icon who gained international attention when he and fellow journalist Carl Bernstein broke news of the Watergate scandal. Their book, All the President’s Men, won a Pulitzer price.  He won a second Pulitzer in 2003 for his coverage of 9-11. He has written or coauthored 18 best-selling books. His newest book, Fear: ...
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Blue Cross Blue Shield of Western New York Opioid Management: Blue Cross Blue Shield of Western New York has updated the drug therapy guidelines for its Opioid Management policy.  The Pharmacy and Therapeutics Committee approved updates after conducting its annual review and quarterly new drug evaluations. The changeseffective November 1, 2018, will require that preauthorization for any opioid prescription that contributes to a patient’s first time exceeding a threshold of 90 mg of cumulative morphine equivalent dosing (MED) per day. This MED monitoring strategy empowers pharmacists with visibility to patients’ actual cumulative use – across all claims, ...
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This week’s update includes committee updates from Health Policy Weekend, insurance updates, and a re-cap of Bladder Health month. Health Policy Weekend: Committee Highlights On November 16-17, the Public Policy Council and its reporting committees met to discuss issues ranging from USP Chapter 800 Handling of Hazardous Drugs guidance to coding guidance. Below is a brief overview of their activities. Public Policy Council The Public Policy Council approved three action items on direct to consumer advertising, as well as the 2019 federal and state advocacy priorities. The three items will be sent to the AUA Board of Directors for a vote this winter. ...
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Blue Cross Blue Shield Georgia New Readmissions Reimbursement policy: Blue Cross Blue Shield of Georgia (BCBS GA), an Anthem Company, has updated its Reimbursement policy for Readmissions. Effective January 1, 2019, Anthem does not allow separate reimbursement for claims that have been identified as a readmission to the same facility or another facility that: operates under the same Facility Agreement, has the same tax identification number as the facility, or is under common ownership as the facility. This policy documents the health plan’s guidelines used to identify a readmission and the plan’s guidelines for reimbursement related to a ...
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House and Senate Democrats gained enough wins to seize control of the House of Representatives in January for the first time since 2010. The Democrats won 37 GOP-held seats for a net gain of 35 seats, more than the 23 they needed to take control of the Congress. While Republicans added at least two seats to what was a slim advantage in the Senate. Republicans in the Senate are still hoping to add to their current two-seat majority.  Why it matters: That means it’ll be business as usual in the Senate, with Sen. Mitch McConnell (R-KY.) remaining as majority leader, but a major realignment in the House, with Rep. Nancy Pelosi (D-CA-12.) expected to return ...
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Limited space remains for the AUA’s upcoming Quality Improvement Summit on Saturday, December 8. The event will be held at the AUA’s headquarters in Linthicum, MD, and will focus on both the nation’s opioid problem as well as its solution. This Summit has drawn attention from across the country since it will be urology’s first comprehensive look at this pressing issue. The day will feature didactic presentations and panel discussions. However, the strength of previous summits has been the dialogue between speakers and attendees, and this will certainly continue at the 2018 summit. Attendees have noted previously that the exchange between those in the field ...
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AUA 2018 MIPS Reporting Webinar January 8, 2019 at 1 p.m. ET. Free for AUA members and subscribers to the Practice Managers Network Join the AUA on January 8 at 1 p.m. (ET) for a live Webinar on MIPS reporting. This unique program, developed just for AUA members and PMN subscribers, features experts from the Centers for Medicare & Medicaid Services (CMS) who will discuss the ins and outs of MIPS reporting.  The Webinar will address all four areas of reporting — Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information) and Cost — plus topics like who is required to report and how to earn bonus points. ...
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The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016, and the final payment adjustment year is 2018. Therefore, the Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports will no longer be available after the end of 2018. These reports are valuable resources to use for Merit-based Incentive Payment System (MIPS) reporting. The Quality program is nearly identical to PQRS, and Cost is similar to the Value Modifier. Therefore, it may be helpful to review these past reports to see if any mistakes were made in order to prevent making them in MIPS reporting. Another example of how to use these ...
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Coding Q&A

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Each week, the AUA Practice Managers’ Network (PMN) provides examples of how to approach a coding problem or provide insight into a coding inquiry. Here are this week's questions: Q: On rare occasions, patients wish to supply a particular type of catheter as they may have a preference outside of what we carry.  When we do not supply the catheter, would we bill CPT code 51702-modifier 52 for the appropriate reduction of the charge for the supply? A: The catheter is part of the practice expense that is included in the procedure.  A modifier 52 would be used to reduce the work of the procedure, not the practice expense.  There is no modifier ...
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This week’s update includes information on our meeting with Representative Neal Dunn on issues impacting veterans as well as insurance updates from Independence Blue Cross, Horizon Blue Cross Blue Shield. Veterans Affairs: AUA VA Health Workgroup Chair Dr. Jeremy Shelton Meets with Member of Congress on Improving Urologic Care On November 15, 2018, Dr. Jeremy Shelton – along with the AUA staffer Quardricos Driskell – met Rep. Neal Dunn, MD (R-FL-2), urologist, and chairman of the House Veterans’ Affairs Subcommittee on Health and House Veterans Affairs Committee. Both Rep. Dunn and the Veterans Affairs Committee have oversight and investigative jurisdiction ...
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Independence Blue Cross Oral Oncology Agents Pharm Policy:  Independence Blue Cross (IBX) has updated the changes to policy scope, adding Erleada to the policy. Erleada is indicated for the treatment of non-metastatic castration-resistant prostate cancer.  This oncology agent is approved when one of the following inclusion criteria is met: Drug is FDA-approved for indication and regimen requested, including confirmation by genetic and/or biomarker testing when appropriate; or The indication and regimen are classified as Category 1 or 2A by National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium™; or The narrative ...
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This update includes news from the American Medical Association’s House of Delegates meeting as well as news on our Insurance Roundtable with more than 33 commercial insurers, Medicare Administrative Contractors, and specialty societies. AMA House of Delegates Interim Meeting Recaps AUA Delegates Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, Resident and Fellow Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – joined hundreds of physicians at the American Medical Association (AMA) House of Delegates 2018 Interim Meeting to consider resolutions and reports covering clinical practice, payment, ...
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On November 9, the AUA hosted its first insurance roundtable, bringing together representatives from commercial insurers, Medicare Administrative Contractors (MACs) and specialty societies to discuss issues of mutual concern, such as prior authorization, telemedicine and coverage issues. Over the course of the day, specialty society representatives engaged with leaders from Aetna and UnitedHealth Group for a full day of panel discussions and dialogue around topics of import to both private insurers and MACs. Additional topics addressed included: Medicare Advantage plans; Implementation and restraints for new technologies; Use of mid-level providers; ...
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The American Urological Association’s Delegates – Drs. Aaron Spitz and Willie Underwood, Alternate Delegate Dr. Terry Grimm, Resident and Fellow Section Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – joined nearly 600 other physicians at the American Medical Association’s (AMA) House of Delegates 2018 Interim Meeting to consider resolutions and reports that would establish policy on health, medical, professional and governance matters. Regular updates were posted to the Policy & Advocacy Brief blog over the course of the meeting and can be reviewed here . Recap: Days 3 and 4:   On November 12-13, the AUA delegates ...
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