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Government and Regulatory Update Dr. Thomas Rechtschaffen kicked off the day with an update on what attendees should know about government and regulatory issues. Dr. Rechtschaffen discussed topics including USPSTF reform, urology workforce shortages and the importance of state-level regulatory issues in urology. Coding and reimbursement topics were also discussed, including the importance of physician participation in the RUC survey. MACRA Update – What your Practice Needs to Know Dr. Franklin Gaylis, chief scientific officer at Genesis Healthcare Partners, was joined by Dr. Ashby Wolfe, Chef Medical Officer, Region IX from the Centers for Medicare ...
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Maintaining Independence as a Practice Max Reiboldt, President and Chief Executive Officer at Coker Group, presented “Maintaining Independence as a Practice.” Reiboldt’s presentation focused on the economic structures of private practices and explored multiple health system alignment models. He outlined scenarios in which his team personally developed for urologists wherein they maintain systematic independence and privatization while aligning with other groups and/or health systems. Moving from Volume to Value- Determining the Cost of Care Dr. Neil Baum lead a presentation entitled “Moving from Volume to Value- Determining the Cost of Care." ...
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This week’s update includes information on our joint support of research with the Friends of the National Institute on Aging, insurance updates, and top takeaways from Centers for Medicare & Medicaid Services (CMS) May 4 Clinician Outreach Meeting. Patient & Research Advocacy: AUA Joins New Research Coalition The AUA joined the Friends of the National Institute on Aging (FoNIA), a broad coalition of organizations committed to the advancement of health sciences research that affect millions of older Americans. FoNIA supports the research and training missions of the National Institute on Aging (NIA) and serves as a bridge between the NIA and supportive ...
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Participating in the Centers for Medicare & Medicaid Services’ (CMS) Merit-based Incentive Payment System (MIPS) has become more important this year than ever before. In the inaugural year of 2017, participants were able to “pick their pace.” However, that option has been discontinued, and those that do not participate in MIPS reporting in 2018 will face a 5 percent penalty on their Medicare Part B services. Alternatively, CMS will reward top tier reporters with up to a 5 percent bonus. So, the incentive to participate in MIPS reporting and to do it well is clear. In order to help members achieve reporting success, the AUA has created the MIPS Toolkit ...
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As of January 1, 2018, if a physician performs CPT code 52000 Cystourethroscopy (separate procedure) in tandem with CPT codes 57240 Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed , 57260 Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed ; or 57265 Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair , the work of the cystourethroscopy is included in the colporrhaphy codes. When a physician performs a surgical repair of a defect in the vaginal wall, including a cystocele (when the bladder protrudes ...
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In some situations, it may be necessary to indicate that the performance of a procedure or service during the postoperative period was a) planned or anticipated (staged); or b) more extensive than the original procedure; or c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. According to Understanding Modifiers , modifier 58 describes a staged or related procedure or service performed by the physician or other qualified health care professional during the postoperative period . The performance of the planned or related service should be documented in the original operative ...
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Top takeaways from Centers for Medicare & Medicaid Services (CMS) May 4 Clinician Outreach Meeting focused on the appeals and grievances in Medicare Advantage, an update on the Open Payments program and an update on new Medicare cards. Appeals and Grievances in Medicare Advantage Medicare health plans, which include Medicare Advantage (MA) plans – such as health maintenance organizations, preferred provider organizations, medical savings account plans and private fee-for-service plans – cost plans and health care prepayment plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare Advantage regulations. ...
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Harvard Pilgrim Reimbursement of Codes with PC/TC Indicator of 3:   Beginning July 1, 2018 for commercial members, Harvard Pilgrim will no longer reimburse a physician or other health care professional for a procedure code that CMS has assigned a PC/TC indicator of 3 when it is billed with a facility place of service code, because those procedure codes are payable only to the facility. A PC/TC indicator of 3 identifies stand-alone codes that describe the technical component — such as staff and equipment costs — of selected procedure codes. Codes with a PC/TC indicator of 3 should not be billed by the physician because this indicator represents work done ...
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This week’s update includes information on our advocacy opposing price fixing and inappropriate prior authorizations, as well as our coalition advocacy supporting the Department of Defense Research Programs. In case you missed it, yesterday, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation statement on Screening for Prostate Cancer. The AUA shared this press release in response to this statement.  The AUA has communicated with all eight Sections, subspecialties, and patient advocacy organizations who jointly issued a letter on the draft recommendations last year. The goal is to reissue a joint statement later this month. ...
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To continue preparation efforts for the full committee markup of the Fiscal Year 2019 National Defense Authorization Act (NDAA) later this month, on May 2 the AUA met with staff from Senator Gillibrand’s office (D-NY). This concluded a long series of meetings led by the Defense Health Research Consortium (DHRC) with members of the House/Senate Armed Services Committees to educate offices about the overall value of the Congressionally Directed Medical Research Programs (CDMRP) and encourage offices to avoid the inclusion of any language in the NDAA that would threaten the continuation of these high risk/high reward programs. Meetings emphasized that the research ...
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On May 3, our partners at Men’s Health Network (MHN) notified the AUA that they have submitted a request to the USPSTF that it perform a full review of its recommendation on testicular cancer self-examination. As was pointed out by MHN – and Dr. Ajay Nangia (representing the Society for the Study of Male Reproduction ) during his presentation at the Annual Urology Advocacy Summit – a full review of testicular self-exam has not been done by the USPSTF since it issued a “D” grade for the service in 2004. MHN also has published an article in the Journal of Men’s Health discussing the request for a full review of the self-exam by the USPSTF. This lapse ...
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The AUA, via its State Advocacy Committee chaired by Dr. Bill Gee, has joined a coalition that opposes California Assembly Bill 3087 , which would establish a government-run commission to set the prices that providers can charge for medical services. This legislation is far reaching and would have a dramatic impact on the state’s provider community. The California Medical Association predicts that this legislation will force many solo and small practices to close entirely or force their absorption into larger groups. The bill has passed the California State Assembly Health Committee and is now before the Assembly Appropriations Committee. The California Medical ...
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Palmetto Billing and Coding for the Rezum System for Benign Prostatic Hyperplasia (BPH) - LCA (A55944): Palmetto has added a new article addressing billing and coding for the Rezum system for benign prostatic hyperplasia (BPH). The article states that claims for procedures involving Rezum steam injection should not be coded as CPT 53852 because the technology does not apply radiofrequency (RF) energy to the prostate. Prostatic tissue destruction is accomplished via steam generated by RF, not by the RF itself.   Hospital Outpatient Setting or Ambulatory Surgical Center:  Effective January 1, 2018, claims billed for procedures involving Rezum should ...
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The American Urological Association (AUA), today released the following statement in response to the U.S. Preventive Services Task Force (USPSTF) final recommendation statement on Screening for Prostate Cancer. The statement below is attributed to AUA President J. Brantley Thrasher, MD, FACS: The AUA commends the USPSTF for its decision to maintain its upgraded recommendations for prostate cancer screening in men ages 55 to 69. The final recommendations released today support screening in this age group and are in direct alignment with the AUA’s clinical practice guideline and guidelines from most other major physician groups – including the American Cancer ...
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A series of plenaries will take place at the upcoming AUA annual meeting based on AUA clinical guidance documents and related programs.  All of the plenary projects are being addressed by various committees and workgroups under the auspices of the AUA’s Science & Quality Council. Saturday, May 19 1:30-1:45 p.m. (Plenary: Next Frontier) AUA QI Summit: Challenges and Opportunities from Stewardship of Urological Imaging – On October 21, 2017, the AUA partnered with the American College of Emergency Physicians and the American College of Radiology to host its third Quality Improvement Summit on improving patient safety and ensuring appropriate use of ...
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Following the Florida state Supreme Court ruling that the state’s caps on non-economic damages was unconstitutional, the medical liability climate in Florida has changed significantly. The June 2017 ruling voided a 2003 law put in place by then-Governor Jeb Bush (R). The Court’s decision was 4-3, and stated that the cap violated the state’s equal protection clause. Non-economic damages, also known as “pain and suffering,” differ from economic damages in that they are often subjective and hard to quantify. The case in question involved a patient who experienced an adverse event during and immediately after surgery at a Broward County hospital. A jury awarded ...
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Time is running out to attend and seats are filling up fast for the 2018 AUA Practice Management Conference , being held May 17 – 18, 2018 at the Moscone Convention Center in San Francisco.  Physicians and practice managers – as well as administrators in all practice type settings will greatly benefit from the education and resources delivered at this conference.  Click here for the CME and registration information for the conference. Topics offered at this year’s conference include Contract Negotiating, Measuring Outcomes, Patient Engagement and Satisfaction, Financial Operations and Benchmarking for your practice, Update on USP800 Regulation, MACRA update, ...
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Get the latest on urology coding from AUA experts at the 2017 AUA Coding Seminar on July 20- 21 , at the Westin Las Vegas Hotel in Las Vegas. This seminar is designed to update your CPT coding skills and as well as improve your surgical coding skills and will extend your urology coding knowledge beyond the textbook and into the realm of patient collections, key practice issues, audit-proofing and more. In addition to the seminar, Friday workshops will offer Coding Basics and Surgical Coding Challenges, along with a new Practice Essentials workshop, led by Practice Management Committee Chair Jay Motola, MD, that will feature a half-day program exploring ...
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Through its TeamSTEPPS series, the Agency for Healthcare Research and Quality (AHRQ) is offering a free online course, which focuses on enhancing communication and teamwork skills among office-based professionals to improve patient safety and quality. Not only can providers obtain continuing education credits for this program, but also those participating in the Merit-based Incentive Payment System (MIPS) can use this as an Improvement Activity . Register now to take advantage of this free resource. TeamSTEPPS is an evidence-based teamwork system, which optimizes patient outcomes by improving communication and teamwork skills among healthcare professionals. ...
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The Food and Drug Administration (FDA) is advising consumers not to purchase Eurphoric capsules packaged in one-count blister cards, three-count bottles, and 12-count bottles. An FDA analysis found samples of Euphoric to be tainted with undeclared sildenafil and tadalafil, active ingredients in two FDA-approved prescription drug products, also known as phosphodiesterase 5-inhibitors (PDE-5 inhibitors), used to treat male erectile dysfunction (ED). While there are no reports of illness associated with this supplement, it could pose a threat to consumers because the undeclared product can interact with nitrates found in some prescription drugs (such as nitroglycerin) ...
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