Blogs

AUA Advocacy Snapshot: Week of January 21, 2019

By Policy and Advocacy Brief posted 2 days ago
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This week’s update includes news on our meeting with Senator Bill Cassidy’s office as well as a briefing with Congressional members promoting reauthorization of funding for the Patient-Centered Outcomes Research Institute in 2019. Congressional Outreach: AUA Holds Policy Meeting with Senator Cassidy’s Office On January 17, the AUA met with the office of Sen. Bill Cassidy, MD (R), the senior senator from Louisiana. A strong supporter of the AUA’s issues, Dr. Cassidy is a member of both of the committees that oversee health policy: Health, Education, Labor & Pensions (HELP) and Finance. The meeting served as a way to identify issues that both Dr. Cassidy ...
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Insurance Updates: Week of January 21, 2019

By Policy and Advocacy Brief posted 2 days ago
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Health Alliance Plan of Michigan Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction and Fecal Incontinence and Constipation: Health Alliance Plan of Michigan has revised its Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction medical policy. The company has added posterior tibial nerve stimulation (PTNS) to policy and now, PTNS may be considered medically necessary when criteria are met. The company has also added exclusions of coverage for PTNS, which include, but are not limited to, the following: Urinary indications except overactive bladder (OAB) as those uses are considered experimental, investigational, ...
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Updates on Availability of BCG

By Policy and Advocacy Brief posted 6 days ago
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As part of our ongoing efforts to monitor drug supply issues, the AUA recently reached out to Merck regarding member concerns about recent changes in availability for bacillus Calmette-Guerin (BCG). Due to increased need globally for BCG and anticipated supply constraints, Merck has announced a shift in the distribution model for its TICE ® BCG product and is in the process of communicating changes with providers and practices. Learn more from the FDA. The AUA will continue to provide updates as information becomes available. Members with questions are urged to contact the Merck National Service Center at 1-800-672-6372
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Merit-based Incentive Payment System (MIPS): 2108 and 2019 Reporting Information

By Policy and Advocacy Brief posted 7 days ago
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The first quarter of 2019 straddles the MIPS seasons of both 2018 (Year 2) and 2019 (Year 3) of the program. The 2018 submission period just opened, and participants have until April 2 to send their data to the Centers for Medicare & Medicaid Services (CMS). However, some participants are ready to begin 2019 reporting. For those practices, a synopsis of the differences between the two reporting years is noted and a list of 2019 resources has been compiled. 2018 Data Submission Period Now Open CMS has officially opened the data submission period for MIPS eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program (QPP). Apart ...
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Event Recap: 2018 AUA Quality Improvement Summit

By Policy and Advocacy Brief posted 7 days ago
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The 2018 Quality Improvement Summit was held at the American Urological Association (AUA) headquarters in Linthicum, MD, on Saturday, December 8, 2018. Nearly 100 attendees participated in the event, which focused on opioid stewardship in urology. Chaired by Drs. Angela Smith of the Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill and Gregory Auffenberg of Northwestern University’s Feinberg School of Medicine, the Summit featured didactic presentations, panels, and question and answer sessions that allowed the audience to share their experiences. Speakers represented various disciplines in order to demonstrate the need ...
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AUA Advocacy Snapshot: Week of January 14, 2019

By Policy and Advocacy Brief posted 8 days ago
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This week’s update includes information on the AUA’s participation in the Alliance of Specialty Medicine’s meeting with the Centers for Medicare & Medicaid Services to address challenges with Medicare Advantage, as well as our meeting with Representative Jackie Walorski on workforce issues. Congressional Outreach: AUA Meets with House Ways & Means Member On January 9, the AUA met with Rep. Jackie Walorski (R-IN-2) during a meet and greet sponsored by the Alliance of Specialty Medicine. Congresswoman Walorski serves on the House Ways & Means Committee, which is one of the two House committees with jurisdiction on health policy. During the meeting, ...
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Insurance Updates: Week of January 14, 2019

By Policy and Advocacy Brief posted 9 days ago
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BCBS Arkansas Hormone Pellet Implantation for Hormone Replacement Therapy: Blue Cross Blue Shield Arkansas has revised its hormone replacement therapy coverage policy for females. The company is changing implantable hormone pellets from meeting member coverage criteria to not meeting coverage criteria or being considered investigational. Preauthorization is now required.  BCBS AR states that implantable hormone pellets (testosterone and/or estrogen) do not meet member benefit certificate primary coverage criteria, and requires that there be scientific evidence of effectiveness for females, as a method of hormone replacement therapy (HRT). The company ...
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AUA Advocacy Snapshot: Week of January 7, 2019

By Policy and Advocacy Brief posted 15 days ago
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This week’s update includes information on registering for the 2019 Annual Urology Advocacy Summit and last week’s Centers for Medicare & Medicaid Services’ Clinician Outreach meeting. Annual Urology Advocacy Summit: Agenda Update The Annual Urology Advocacy Summit aims to expand, strengthen  and unify the voice of urology on public policy matters impacting our practices and patients by bringing together  an array of stakeholders, including patient advocates and researchers. This year, sessions will include hot-button topics on issues such as access to urologic care, fertility coverage, opioids, veterans’ health, practice burdens, research and the ...
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Updates: First Friday Clinician Outreach Meeting, January 4, 2019

By Policy and Advocacy Brief posted 15 days ago
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The Centers for Medicare & Medicaid Services (CMS) January 4 Clinician Outreach Meeting focused on the Part D Opioid Policies and Shared Savings Program. 2019 Part D Opioid Policies An opioid script that is written for the first time for that patient can be written for a supply of seven days. In addition, a physician can write a second prescription for an additional amount. CMS expects that the physician and the pharmacist communicate directly regarding the prescription (vs. involving the Medicare Advantage plan). The pharmacy can review the script and they can change the number of pills in the prescription. The pharmacy will receive communications ...
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Insurance Updates: Week of January 8, 2018

By Policy and Advocacy Brief posted 16 days ago
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Tufts Health Plan Evaluation and Management: Tufts Health Plan has updated its Evaluation and Management Policy by adding a statement for modifier 57.  The policy states that: Effective for dates of service on or after 01/01/2019, Tufts Health Plan will not routinely compensate Evaluation and Management (E&M) services without modifier 25 if performed the day prior or the same day as a major surgical procedure and another E&M service has been billed in the previous two months, and the primary diagnosis for all three services is the same to the compensation/reimbursement information section. Read the complete policy. First Coast Service ...
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Optimizing Surgical Outcomes White Papers Approved

By Policy and Advocacy Brief posted 12-18-2018
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The AUA Board of Directors recently approved a series of three white papers focused on optimizing surgical outcomes: Optimizing Outcomes in Urological Surgery:  Pre-Operative Care for the Patient Undergoing Urologic Surgery or Procedure Optimizing Outcomes in Urological Surgery:  Intraoperative Considerations Optimizing Outcomes in Urological Surgery:  Postoperative Timothy Averch, MD, chair of the AUA’s Quality Improvement and Patient Safety Committee which oversaw the work of these documents, commended the overall project.  “The panel chairs John Stoffel, Kristin Chrouser, and Angela Smith and their respective panels did a tremendous ...
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FDA Announces New Consumer Alert

By Policy and Advocacy Brief posted 12-18-2018
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The Food and Drug Administration (FDA) is advising consumers not to purchase or use two e-liquids sold by HelloCig Electronic Technology Co. Ltd. because an FDA laboratory analysis confirmed they contain undeclared ingredients.  E-Cialis HelloCig E-Liquid (sildenafil and tadalifil) E-Rimonabant HelloCig E-Liquid (sildenafil) 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 supplements, they could pose a threat to consumers because the undeclared product can interact with nitrates found in some prescription drugs (such as ...
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Now Available: Physician Compare Preview Period

By Policy and Advocacy Brief posted 12-18-2018
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On November 20, 2018, the Physician Compare preview period officially began. Clinicians and group practices now have the opportunity to preview their 2017 performance information before it is publicly reported on the Physician Compare website in early 2019. The preview period ends on December 31, 2018. The Physician Compare website was created by the Centers for Medicare & Medicaid Services (CMS) to provide patients with useful information about physicians and other healthcare professionals who take part in Medicare. The AUA urges its members to become familiar with Physician Compare.  This website (especially the Downloadable Database portion) contains ...
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Top Ways to Ensure Accurate Coding for 2019

By Policy and Advocacy Brief posted 12-18-2018
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With 2019 quickly approaching, it is important that your practice has several strategies to maintain its financial viability. An easy way to do that is to make sure you have access to trusty coding resources that will aid you in your reimbursement process. Here are few ways to ensure accurate coding at your practice. Update Your Coding Books for 2019: Using outdated books can lead to unnecessary denials or may result in delayed reimbursement, so be sure to obtain the latest edition of the Current Procedural Terminology (CPT®), International Classification of Diseases Clinical Modification (ICD-10-CM), Healthcare Common Procedural Coding Systems (HCPCS) and ...
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Past PQRS Reports Available through the End of 2018

By Policy and Advocacy Brief posted 12-18-2018
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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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AUA Advocacy Snapshot: Week of December 17, 2018

By Policy and Advocacy Brief posted 12-18-2018
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This week’s update includes information on model legislation on prostate cancer screening, as well as One Voice Against Cancer’s annual strategy meeting. We also highlight the launch of our E&M Audit Service. The next Advocacy Snapshot will be posted the week of January 7. State Advocacy Update: AUA Promotes Model Legislation at Prostate Cancer Roundtable On December 12, the AUA participated in a meeting of the Massachusetts Prostate Cancer Coalition, in Boston, MA. The meeting brought together patients, advocates, providers, and industry leaders to discuss the prostate cancer community’s unmet needs and policy solutions to those problems, like the ...
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New CPT Changes for Urology Effective January 1, 2019

By Policy and Advocacy Brief posted 12-18-2018
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Current Procedural Terminology (CPT ® ) has been revised to standardize coding placement under more appropriate headings in an effort to better categorize CPT ®  procedures. New, revised or deleted CPT ® codes are listed below. Code revisions are noted in  green and new codes/additions are noted in  bold . New Codes: Evaluation and Management Digitally Stored Data Services/Remote Physiologic Monitoring 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment ( Do not report 99453 more than once per episode of care ) ( ...
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Insurance Updates: Week of December 17, 2018

By Policy and Advocacy Brief posted 12-17-2018
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Capital Blue Cross Percutaneous Tibial Nerve Stimulation (PTNS): Capital Blue Cross has revised its PTNS policy with the following changes: Changed policy consideration for PTNS from investigational for all indications to medically necessary as an initial 12-week course when criteria are met. Added several ICD-10 codes, including, but not limited to, the following: N32.81 Overactive bladder N39.41 Urge incontinence N39.42 Incontinence without sensory awareness N39.43 Post-void dribbling N39.44 Nocturnal enuresis Updated supporting information under description/background section to add information on voiding dysfunction and associated ...
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AUA Advocacy Snapshot: Week of December 12, 2018

By Policy and Advocacy Brief posted 12-12-2018
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This week’s update includes information on the AUA’s Congressional meeting on step therapy as well as highlights from the Centers for Medicare & Medicaid Services’ Clinician Outreach meeting. Step Therapy: AUA, Regulatory Relief Coalition Congressional Meeting On December 4, the AUA met with the office of Sen. Chuck Grassley (R-IA) as part of our ongoing efforts with the Regulatory Relief Coalition, which is a group of provider organizations looking to ease the various regulatory burdens being placed on physicians. The meeting addressed the issue of step therapy in the Medicare Advantage program. As the incoming chair of the Senate Finance Committee, ...
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Insurance Updates: Week of December 10, 2018

By Policy and Advocacy Brief posted 12-10-2018
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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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