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This week’s Snapshot includes an update on AUA advocacy on appropriate reimbursement for the cystoscopy code (CPT 52000), meetings with the Congressional Black Caucus members and congressional staff on issues such as the U.S. Preventive Services Task Force (USPSTF) recommendations and the physician workforce shortage, and the forthcoming open comment period on shared decision-making measures. Cystoscopy Code: AUA RUC Advisor Update AUA RUC Advisor Dr. Thomas Turk has published a Q&A in the AUA Policy & Advocacy Brief blog on our efforts to address recent reductions to CPT 52000 (Cystourethroscopy). The AUA has identified several options to address the ...
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The AUA consistently advocates on our members’ behalves preserving current RVUs for urologic services and surgeries. Each year, the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) makes recommendations to CMS that, in turn, determine how Medicare dollars are allocated. The Relative Value Scale Update Committee (RUC) is an expert panel of physicians which makes recommendations to the government on the resources required to provide a medical service. The expert panel’s assessment takes into account physicians’ time, nurses’ time, supplies and equipment involved in patient care. The RUC is comprised of a volunteer ...
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United Healthcare Effective September 1, 2017, United Healthcare will require physicians reporting evaluation and management services on behalf of their employed Advanced Practice Health Care Professionals to report the services with a modifier to denote the services were provided in collaboration with a physician. UnitedHealthcare will accept the modifier SA on claims for these services when provided by nurse practitioners, physician assistants and clinical nurse specialists. In addition, the rendering care provider's National Provider Identifier (NPI) must also be documented in field 24J on the CMS-1500 claim form or its electronic equivalent. For more information ...
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This week’s update includes information on the AUA’s Congressional meetings with House Ways and Means and freshman offices, our joint advocacy with LUGPA on a draft bill that would address barriers to care coordination in the new Merit-Based Incentive Payment System, insurance updates, as well as a forthcoming Society of Women’s Health Research white paper on bladder health barriers throughout the lifespan. Congressional Outreach: Continued Meetings with House Ways & Means and Freshman Offices Earlier this month, the AUA began a series of meetings with members of the House Ways & Means Committee, which is one of the two major health policy committees ...
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Beginning in 2018, the AUA will implement a three-tiered annual subscription/pricing structure with a variety of participation and budget options to fulfill the specific needs of every urologic practice. Subscription levels include: Basic which provides dashboard access to CMS Quality Payment Program (QPP) measures; Classic which provides full dashboard access without MIPS reporting capabilities; and Elite, for practices that are looking for a single solution to assist with MIPS reporting and other quality improvement activities. Deadlines to sign up for 2017 MIPS reporting through the AQUA Registry: New practices interested in 2017 performance ...
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It’s never too early to prepare your practice for upcoming changes in medical coding. As your practice gears up for another busy year in 2018, it is important to stay current! Update Coding Books: Be sure to always obtain the latest editions of the Current Procedural Terminology (CPT®), International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), Healthcare Common Procedural Coding Systems (HCPCS) and Resource-Based Relative Value Scale (RBRVS) books. Using outdated books may lead to unnecessary denials or may result in delayed reimbursement. Purchasing the new publications each year may seem costly, but it could be even more ...
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The ABIM Foundation announced that it has launched a new   This free app, available through iTunes, provides access to all 500 Choosing Wisely recommendations as well as 150 patient resources. Clinicians and patients can use the app to search the specialty society statements using keywords and filter by specialty, age, setting and service (i.e., imaging, medication, treatment, lab, test).  The recommendations are linked to relevant patient-friendly resources, and both recommendations and patient resources can be shared via text or email. This new feature is currently only offered for the iPhone, but it will be available for iPads in August.  An Android ...
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Cigna Physician Directory Cigna is committed to ensuring that their provider directories are up to date. They are requesting that any provider making changes to their practice to access their website . It is also recommend to visit the directory to ensure all of your information is correct. Testopel Currently claims for Testopel may be reviewed for medical necessity if the requested amount exceeds a certain threshold. Cigna does require prior authorization for all Testopel requests. This change effects claims with dates of service on or after August 25, 2017. For more information click here .   Aetna Medical Records Requests ...
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Top takeaways from the August 4, 2017 Centers for Medicare & Medicaid Services (CMS) Clinician Outreach Meeting focused on the Transforming Clinical Practice Initiative (TCPI), upcoming National Provider Enrollment Conference, and the Physician Regulatory Issues Team (PRIT) Reporting Tool Pilot. TCPI The agency is midway through the TCPI, a large quality improvement initiative currently undergoing a four-year model test. The initiative is looking to enroll more than 140,000 clinicians, mostly in the outpatient setting. To date, the agency has enrolled 120,000 physicians (covering 23,000 practices) into 29 Practice Transformation Networks (e.g., ...
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This week’s update includes information on the American Medical Association’s State Advocacy Roundtable, advocacy to delay and withdraw the Medicare Part B Drug Payment Model, Congressional meetings on our legislative priorities and the AUA-LUGPA supported Medicare Care Coordination Improvement Act. This update also provides a report from the Centers for Medicare & Medicaid Services (CMS) Physician Regulatory Issues Team on the Transforming Clinical Practice Initiative (TCPI), the inaugural National Provider Enrollment Conference, and the Quality Payment Program. State Advocacy: AUA Attends American Medical Association (AMA) State Advocacy Roundtable Meeting ...
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Anthem Blue Cross Blue Shield Provider remittances Beginning in August of 2017, paper provider remittances will have updated information on them to make it easier for providers to identify and track refunds and recoupments. The new section titled “Negative Balanced Deferred” will be listed under the recoupment notification of the remittance. This will allow providers to identify overpayments that have will be recouped in the future. If providers have any questions about this change, they are requested to call the number at the bottom of the recovery letter or remittance. Provider Maintenance Forms Anthem is committed to ensuring that their ...
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This week’s update includes information on a new graduate medical education bill, joint advocacy on a new Food and Drug Administration bill, and an overview of the Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System  proposed rule . Physician Workforce Shortage: New Graduate Medical Education (GME) Bill Introduced Recently, Rep. Jeff Denham (R-CA-10), joined by Rep. David G. Valadao (R-CA-21),  introduced H.R. 3451, the Creating Additional Residency Expansion Act (CARE Act) to further expand the Teaching Health Center Graduate Medical Education (THCGME) program. This bill expands the THCGME program, by creating new residency ...
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The AUA is now accepting applications for the 2017-18 Gallagher Health Policy Scholar program . Since 2007, the American Urological Association (AUA), a leading advocate for the specialty of urology, has offered urologists this unique opportunity to explore policy issues that impact urology by participating in a series of health policy activities. Previous Gallagher Scholars are now among some of the AUA’s top health policy leaders, and attribute participation in this program as a key step in making the transition into leadership roles.   For more information, email  cmcfall@auanet.org .   All applications and required materials must be received ...
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On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASCPS) proposed rule . CMS proposes to update OPPS rates by 1.75 percent and to increase payment rates under the ASCPS by 1.9 percent for CY 2018. In addition, CMS proposes to remove CPT code 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) from the Inpatient Only List and assign it to C-APC 5362 (Level 2 Laparoscopy & Related Services) with status indicator J1. ...
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On June 30, the Centers for Medicare & Medicaid Services (CMS) published the Program Year 2016 Open Payments data, along with newly submitted and updated payment records for Program Years 2013, 2014 and 2015. In Program Year 2016, applicable manufacturers and group purchasing organizations (GPOs) reported $8.18 billion in payments and ownership and investment interests to physicians and teaching hospitals. This amount is comprised of 11.96 million total records attributable to 630,824 physicians and 1,146 teaching hospitals. Payments in the three major reporting categories are $2.80 billion in general (i.e., non-research related) payments, $4.36 billion in ...
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The AUA urges your support for urologic research sponsored by the Department of Defense (DoD) by contacting your Senators today and requesting a YES vote on Senator Richard Durbin's (D-IL) amendment to S. 1519, the National Defense Authorization Act (NDAA) for Fiscal Year 2018. The NDAA and the subsequent amendment will be up for consideration on the Senate floor in the coming weeks. The Durbin amendment is designed to nullify harmful provisions in S. 1519 that would prohibit funding for critical medical research programs at the DoD unless such research meets certain narrowly defined criteria related to active military relevance. Undoubtedly, this language ...
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This week’s update includes information on the AUA’s participation in the We Work for Health advocacy fly-in, a report from the Alliance of Specialty Medicine fly-in, our conversations with Congressional offices on the Better Care Reconciliation Act, Independent Payment Advisory Board repeal, and the Prescription Drug User Fee Act as well as our coalition activities on regulatory reform. This week, the AUA will join more than 170 county, state, and national medical society staff at the American Association of Medical Society Executives annual meeting to discuss issues ranging from implementing the Quality Payment Program and health care financing and delivery ...
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The Alliance of Specialty Medicine held its annual Washington, DC fly-in on July 18-19. Eleven AUA physicians helped make up the more than 150 attendees from 30 different states that converged on Capitol Hill to educate their representatives on the issues affecting specialty practices. The AUA was represented by Public Policy Council Chair Dr. Chris Gonzalez, Legislative Affairs Committee Chair Dr. Tom Rechtschaffen, Legislative Affairs Committee members Drs. Kelly Chiles, Ron Davis, Jason Jameson, and Jeremy Shelton, Gallagher Scholar Dr. Jim Dupree, Holtgrewe Fellow Dr. Josh Langston, and AUA members Drs. Kevin Koo, John Lam, and Ruchika Talwar. During ...
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United Healthcare is striving to make researching claims and eligibility easier for the physicians needing to obtain information. Such claims changes include claim detail enhancements, capitated indicator, and a view or act on your claim feature. Eligibility enhancements include service level deductible indicator, benefit search enhancements and a code lookup tool
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This week’s update includes news from this week’s Alliance of Specialty Medicine advocacy fly-in on Capitol Hill, where urologists and our specialty medicine colleagues covered more than 150 Congressional offices in 30 states. The update also includes information on the Centers for Medicare & Medicaid Services report affecting the Independent Payment Advisory Board as well as proposed rulemaking on the Medicare Physician Fee Schedule and the Quality Payment Program. Next week’s update will include a more -detailed overview of the Alliance meeting. Proposed Rule on Medicare Physician Fee Schedule Released On July 13, the Centers for Medicare & Medicaid ...
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