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This week’s update includes information on the Medicare Payment Advisory Commission’s recommendations regarding the Merit-based Incentive Payment System, the Medicare Extenders package, and insurance news. The AUA also is proud to announce that the Centers for Medicare & Medicaid Services recently approved the AUA Quality (AQUA) Registry as a Qualified Clinical Data Registry for 2018. MIPS: MedPAC Drafts Recommendation for Repeal, Despite Public Concerns Despite concerns raised by the AUA and its colleagues at the Alliance of Specialty Medicine in a letter addressed to Medicare Payment Advisory Commission (MedPAC) Chairman Francis J. Crosson, MD, MedPAC ...
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CGS Administrators Medicare Standard Documentation Requirements: CGS Administrators, LLC has updated its Standard Documentation Policy effective November 20, 2017. CGS is now directing providers to retain written orders for seven years. CGS is the Medicare Administrative Contractor for Jurisdiction B (Durable Medical Equipment, or DME) and Jurisdiction C DME, as well as Jurisdiction 15 Part A and B and Home Health & Hospice (HHH) Medicare. Read the full policy. QualChoice Erectile Dysfunction Policy Update: QualChoice Health has updated and revised the coverage criteria for its erectile dysfunction policy, adding coverage for intraurethral ...
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The AUA’s Practice Management Conference will be held on May 17-18, 2018 at the Moscone Convention Center in San Francisco, during the 2018 AUA Annual Meeting. Physicians, practice managers as well as administrators in all practice type settings will greatly benefit from the education and resources delivered at this conference. Topics such as contract negotiations, business operations for your practice, advanced practice providers’ scope of practice, risk management and compliance issues, patient satisfaction measures and alternative payment models, and much more. These presentations will be coming from some of the top professionals in the field of urology. ...
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The AUA added a new appeal letter on the AUA website to assist members in the event that a medical claim for the transurethral destruction of prostatic tissue by radio-frequency generated water vapor thermotherapy (Rezum®) is denied. This letter can accompany any documentation submitted to any insurer (Medicare and private) to use upon appeal.  The letter can be found here .
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If you have not submitted your 2017 Merit-based Incentive Payment System (MIPS) data, it is not too late. The Centers for Medicare and Medicaid Services (CMS), which oversees MIPS, extends the reporting deadline a few months into the next calendar year, allowing busy providers the opportunity to send their information and hopefully avoid the 4 percent penalty for not participating. For the 2017 reporting year, the deadline will be March 31, 2018 for all programs and reporting mechanisms. While the deadlines for the programs are now unified, the beginning dates vary. For example for Quality reporting, those using claims reporting have already been submitting ...
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Three times yearly, the Relative Value Update Committee (RUC) sets values for Current Procedural Terminology (CPT) codes that have been identified for review/update. As a part of this review process, specialty societies send RUC survey instruments out to random samples of their memberships to obtain real-world feedback to inform the RUC process. The survey is an important tool to collect objective data that is used to assign a specific relative value for the CPT code in question. The RUC survey is an online assessment tool completed by physicians who perform the procedures. Still not sure why you should complete a RUC survey or how to do it? The American ...
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This week’s update includes information on AUA opposition to a Congressional misvalued code offset provision and our patient advocacy work as part of the webinar Driving Positive Change for Patients through Collaboration and Education. Medicare Extenders: AUA, Alliance of Specialty Medicine Oppose Offset The AUA and its colleagues in the Alliance of Specialty Medicine have sent a letter to House Ways and Means Committee Chairman Kevin Brady (R-TX-8) and Ranking Member Richard Neal (D-MA-1) expressing deep concerns with the misvalued code offset provision included in the Medicare extenders package released on November 15. Recently, Committee Chairman ...
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NGS Medicare Denials for Modifier 59 and 91: National Government Services (NGS Medicare) is a Medicare Administrative Contractor (MAC) for Jurisdiction 6 and Jurisdiction K.  Jurisdiction 6 consists of Illinois, Minnesota and Wisconsin, and  Jurisdiction K consists of Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.  Recently, NGS reported a hefty amount of denials during audits and has issued instructions for modifiers 59 and 91. In order to avert any hindrance of future claims, please read the proper use of the modifiers 59 and 91 below.  Modifier 59 Claim submissions and redeterminations received by National ...
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This week’s update includes information on the AUA’s meeting with the Centers for Medicare & Medicaid Services on prior authorization, our legislative priorities, radio-frequency generated water vapor thermotherapy, and news from the State Advocacy Committee. Regulatory Relief: AUA Urges CMS to Address Prior Authorization under Medicare Advantage On November 28, the AUA, in partnership with the Regulatory Relief Coalition, met with the Centers for Medicare & Medicaid Services (CMS) to discuss concerns that Medicare Advantage plans’ use of prior authorization requirements may illegally obstruct access to care. Read more here . Radio-frequency Generated ...
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The scope and extent of prior authorization requirements enforced by Medicare Advantage plans may in fact illegally obstruct access to medically necessary health care services, according to the Regulatory Relief Coalition, a group of medical specialty organizations committed to working with decision makers to overcome regulatory burdens. During a November 28 meeting with Centers for Medicare & Medicaid Services (CMS) Deputy Administrator Demetrios Kouzoukas to discuss inappropriate use of prior authorization by Medicare Advantage plans, the Coalition – of which the AUA is a member – shared its opinion that the sole function of prior authorization appears to ...
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Dean Health Plan Genetic Testing for Somatic Tumor Markers: Dean Health plan has updated the Genetic Testing for Somatic Tumor Markers medical policy #MP9486.  They have added prostate cancer screening and prognostic genetic tests to the medically necessary criteria for ConfirmDX and PCA3 Assay for prostate cancer when the results will impact management.  What this means for physicians performing this testing on a patient with Dean Health is that it will be covered as long as the criteria are met.  Read the full policy. Palmetto GBA Jurisdiction J Transition: For the transition of the Medicare Administrative Contractor (MAC) Cahaba (jurisdiction ...
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This week’s update includes information on the Alliance of Specialty Medicine and AUA’s meeting with MedPAC, patient advocacy activities, insurance updates, and our practice management activities. Congratulations to Dr. Jason Jameson, who was named the 2018 AUA Gallagher Health Policy Scholar! (See full article here .) MIPS: Alliance of Specialty Medicine, AUA Meet with MedPAC On November 8, the AUA and its colleagues at the Alliance of Specialty Medicine met with Medicare Payment Advisory Commission (MedPAC) staff to discuss the concerns raised in the Alliance’s October 24, 2017 letter to the group. On November 2-3, 2017, the MedPAC reconvened ...
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The American Urological Association (AUA) today announced on November 17 that Dr. Jason Jameson has been selected as the 2018 Gallagher Health Policy Scholar. This program is designed to train the next generation of urologists for leadership positions in health policy. Gallagher scholars spend a full year engaged in critical seminars, conferences and meetings at the national level, receive mentoring from AUA physicians in senior roles and participate in a week-long health policy seminar for surgeons sponsored by the American College of Surgeons and held at Brandeis University. Scholars also engage in other educational activities that ensure their immersion ...
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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 hidden ingredients.  Hard Times for Men – sildenafil Tiger 5000 - sildenafil and tadalafil Both of these supplements contain active ingredients found in FDA-approved prescription drugs 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) ...
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As 2017 quickly comes to a close, it is time to take action regarding Merit-based Incentive Payment System (MIPS) reporting, and the AUA is here to help you. To assist with the inaugural year of MIPS reporting, the AUA has created many resources and webinars and has gathered into a central location various tools created by other organizations. Utilize these tools to complete MIPS reporting and avoid the negative payment adjustment (penalty). Remember those who do not participate in 2017 will incur a 4 percent payment adjustment or penalty on all Medicare Part B earnings in 2019. Why make this sacrifice? Anyone new to reporting should utilize the MIPS ...
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As the AUA prepares to launch the inaugural Annual Urology Advocacy Summit in 2018, the AUA Residents and Fellows Committee is partnering with the AUA Public Policy Council to highlight the breadth and scope of AUA members’ engagement and to encourage trainees and young urologists to get involved in local, regional, and federal health policy and advocacy activities . Dr. James M. Dupree is assistant professor of urology at the University of Michigan and specializes in male infertility. He is a member of the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC) Workgroup, comprised of urologists who evaluate the ...
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Even as physician organizations – including the AUA and members of the Alliance of Specialty Medicine – advocate for modifications to the current Merit-based Incentive Program (MIPS), the Medicare Payment Advisory Commission (MedPAC) is continuing its discussions regarding repeal and replacement of MIPS. During its November meeting, MedPAC shared more details regarding its Voluntary Value Program (VVP). Under the VVP, 2 percent of fee-for-service (FFS) reimbursement is withheld to fund a pool. Clinicians would choose to either form a voluntary group and potentially earn a value payment based on their performance on a set of population-based measures, or join ...
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Dean Health Plan MRI-TRUS Fusion- Guided Prostate Biopsy: Dean Health plan has updated the MRI-TRUS Fusion-Guided Prostate Biopsy medical policy #MP9492.  For the diagnosis of prostate cancer, when doing this procedure, it will require prior authorization through the Quality and Care Management Division. MRI-TRUS is considered medically necessary after one or more negative TRUS biopsies and individual is considered at high risk due to:   Persistently elevated PSA; or 2 Rising PSA. 2.0 All other indications for MRI-TRUS Fusion-Guided Biopsy are considered experimental and investigational and, therefore, are not a covered service.  When ...
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This week’s update comes to you from the American Medical Association (AMA) House of Delegates 2017 Interim Meeting, where AUA Delegates joined hundreds of physicians to consider resolutions and reports covering clinical practice, payment, medical education, and public health topics.  View our update from the first two days of the meeting. View our update from day three of the meeting. Our additional updates include information on the 2018 National Defense Authorization Act Conference Report, our support for the Prostate Cancer Misdiagnosis Elimination Act, and the 2018 Practice Management Conference. Patient Advocacy: FY2018 National ...
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The American Urological Association’s Delegates – Dr. Aaron Spitz and Dr. Willie Underwood, Alternate Delegates Drs. Terry Grimm and Roger Satterthwaite, Resident and Fellow Delegate Dr. Hans Arora, and Young Physicians Section Delegate Dr. Trey Raybourn – have joined hundreds of physicians at the American Medical Association (AMA) House of Delegates 2017 Interim Meeting to consider resolutions and reports covering clinical practice, payment, medical education, and public health topics.  View our update from the first two days of the meeting. On November 13, the AUA delegates spent the day in the general session where the AUA delegation and dozens of others ...
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