Blogs

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Aetna revised its Complementary and Alternative Medicine and Tumor Markers Policies, whereas Blue Cross Blue Shield (BCBS) Tennessee released a draft Botox Policy and new Prostate Cancer BRCA1 and BRCA2 Genes Utilization Management Guidelines. Additionally, BCBS South Carolina, ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Kansas City Missouri revised its Genetic Cancer Susceptibility Using Next Generation Sequencing, and Prostate Cancer Screening Policies, and released new Prostate Biopsies APEA and Urinary Tumor Markers for Bladder Cancer APEA Policies. Additionally, ...
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The data submission period for the 2019 Merit-based Incentive Payment System (MIPS) closed on April 30, 2020. Those that submitted data to the program are now able to review their 2019 MIPS preliminary performance feedback data. It must be noted that this is not the final score or feedback, which the Centers for Medicare & Medicaid Services (CMS) plans to release in July 2020.   The AUA will announce in the Advocacy Brief and its other publications when this information becomes available. Between now and July, one’s score could change from the preliminary score based on any of the following: All-Cause Readmission Measure for the Quality performance ...
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Registration is now open for those who which to participate in the Quality performance category of the 2020 Merit-based Incentive Payment System (MIPS) via the Web Interface and/or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey. Groups, virtual groups, and Alternative Payment Model (APM) Entities must have 25 or more clinicians (including at least one MIPS eligible clinician) to register to use the CMS Web Interface. Groups, virtual groups, and APM Entities must have two or more clinicians (including at least one MIPS eligible clinician) to register to administer for the CAHPS for MIPS Survey. If a group ...
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COVID-19 relief, workforce concerns, liability and personal protective equipment (PPE) are among the topics discussed. Sen. Thom Tillis (R-NC) On May 11, AUA attended a webinar and participated in an interactive conversation with Sen. Thom Tillis about the congressional response to the COVID-19 pandemic. Sen. Tillis serves on the Senate Veterans’ Affairs Committee. The conversation centered on the next legislative package of COVID-19 regarding the payment protection program (PPP) and employer/medical liability issues. The senator discussed the effort he is leading to include more aid for the scientific research workforce in the next round of stimulus ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Aetna reviewed its Urinary Incontinence Policy. Blue Cross Blue Shield (BCBS) Minnesota revised both its Prostatic Urethral Lift and Water Vapor Energy Ablation for Benign Prostatic Hyperplasia policies, and Palmetto retired its Minimally Invasive Treatment for Benign Prostatic ...
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There's good news for men in Maryland as state leaders move forward in approving legislation prohibiting cost-sharing for prostate cancer screening tests. New York passed a similar law in 2018. HB 852 ( SB 661 ) Prostate Cancer Screening Coverage Services – Prohibiting Cost-Sharing by Maryland House Delegate Erek Barron (D) was enacted and will become law on January 1, 2021. HB 852/SB 661 specifically requires the state of Maryland to cover a digital rectal exam and a PSA test for men between 40 and 75 years old and men who are at high risk of developing the disease. Since the AUA State Advocacy Committee began working on this important issue in ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Aetna revised its Urinary Incontinence Policy. Blue Cross Blue Shield (BCBS) released an Erectile Dysfunction Policy and BCBS Michigan revised its Percutaneous Tibial Nerve Stimulation Policy. Also, BCBS Minnesota reviewed its Gender Affirming Procedures for Gender Dysphoria ...
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As Arizona, Florida and Nebraska announce plans to re-start non-urgent surgeries and procedures, medical associations and state societies in California and New Hampshire provide guidance for moving forward. Arizona Governor Doug Ducey (R) issued an Executive Order that states, starting May 1, hospitals and other health facilities can resume conducting elective surgeries if they can show they have implemented measures intended to keep health care workers and patients safe. These measures include: Demonstrating greater than a 14-day supply of personal protective equipment; Ensuring adequate staffing and beds; Testing patients prior to ...
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On April 24, the AUA, along with member organizations of the Surgical Coalition, signed onto a letter to the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). It provides feedback on the CMS and the ONC final rules on interoperability, patient access, information blocking and the ONC health IT certification program. It also provides recommendations for the CMS Quality Payment Program (QPP). The following is a summary of the recommendations in this letter. CMS Quality Payment Program (QPP): Extend the Automatic Extreme ...
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The COVID-19 pandemic has not slowed the AUA’s outreach with lawmakers in Washington. Below are summaries for lawmaker meetings in which the AUA participated in late April. Rep. John Joyce, MD (R-PA-13):  On April 27, the AUA, along with its colleagues in a coalition of medical and dental political action committees (MaDPAC), participated in a virtual meeting with Rep. John Joyce, MD. Dr. Joyce, a licensed dermatologist, informed the group that the House GOP Doctors Caucus is looking to address the issue of differences in reimbursement between video and audio-only telehealth services, as audio-only tends to be the only option for older patients and those ...
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An update on new prostate cancer screening measures being considered by state legislatures. Alabama On April 27, the AUA sent a support letter for SB 157 sponsored by Alabama Senator Greg Albritton (R). SB 157 is a budget bill that includes $250,000 in funding for prostate and colorectal cancer screenings. Last week, SB 157 passed the Senate Finance and Taxation General Fund Committee and now awaits further consideration by the full State House. As a reminder, expanding prostate cancer screening coverage in all 50 states is a top advocacy priority for the AUA. We will keep you updated as measures such as these move forward.  Illinois The ...
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On April 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as the country reopens after weeks of closure due to the COVID-19 pandemic. Top changes in this rule include: An increase in reimbursement rates for audio-only telephone evaluation and management (E/M) services (including many behavioral health and patient education services); CMS will add new telehealth services on a sub-regulatory basis and will consider requests by practitioners for new services; Increased telehealth ...
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The U.S. Food and Drug Administration (FDA) recently approved Jelmyto ® , a mitomycin 0.4% gel formulation, for the treatment of patients with low-grade upper tract urothelial cancer. Jelmyto uses reverse thermal hydrogel technology that is a liquid when cool (when it can be instilled) and then turns into a gel when reaching body temperature. That way, the medication can be retained in the renal pelvis/calyces and not immediately excreted. It can be instilled by either a retrograde or antegrade (through a nephrostomy tube) approach. The volume of instillation is based upon the renal pelvis/calyces volume. The concentration of mitomycin is 4mg/ml, and the maximum ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. AmeriHealth, Independence Blue Cross released several policy revisions, including its eviCore Lab Management Program, Genetic Testing, Molecular Diagnostics, and Multiple Surgical Payment Reduction Policies. Blue Cross Blue Shield (BCBS) Michigan, Blue Care Network revised its ...
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The U.S. Department of Health and Human Services (HHS) has begun the distribution of an additional $20 billion of the $50 billion general distribution to Medicare facilities and providers impacted by COVID-19, augmenting the $30 billion that was allocated earlier in April. The general allocation seeks to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures and the economic impact on providers incurring additional expenses caring for COVID-19 patients. In order to receive payment, eligible providers must submit required revenue information for verification and attest to the terms and conditions of this ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and Telehealth/Telemedicine specific newsletters and policy updates. In addition, Horizon Blue Cross Blue Shield (BCBS) New Jersey released changes to its Jevtana and Proleukin policies. National Government Services revised its Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy, and Fluid Jet System in the Treatment of Benign ...
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The AUA continued to work with like-minded provider groups in pushing various key provisions to be included in the fourth COVID-19 legislative relief package, which could be brought up by Congress later this month. On April 16, in conjunction with the AUA and other member groups, the Alliance of Specialty Medicine sent a comprehensive letter to House and Senate leadership outlining various issues that the Alliance would like to see addressed, or further clarified, in its next relief bill. This includes focusing on physician workforce shortages by increasing graduate medical education training slots and enacting H.R. 5924, which is legislation the AUA worked to ...
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The AUA needs your help to protect patients and the healthcare providers that are working on the front lines of the COVID-19 pandemic. Healthcare professionals and facilities are facing challenges, unlike anything in our modern medical history. They put themselves at risk each day while facing workforce shortages, inadequate safety supplies, and insufficient information or changing guidance from federal, state, and local government officials. Despite this, they continue to go above and beyond, doing everything possible to treat the sick and bring comfort to others, often without regard to their own personal well being. That’s why Congress must now act to ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and Telehealth/Telemedicine newsletters and policy updates. Aetna updated its Benign Prostatic Hyperplasia, Biofeedback, and Electrical Stimulation for Pain, Erectile Dysfunction, Near-Infrared Vascular Imagining and Near-Infrared Fluorescence Imaging, and Urinary Incontinence Policies. Anthem revised its Robotic Assisted Surgery, and Taxotere, ...
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