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Blog Entry
Please Take the Global Surgery Payment Survey Today!

Urologic community data needed to combat the Centers for Medicare & Medicaid Services’ latest regulatory burden to be placed on surgeons. On July 15, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a unilateral decision to implement a new sweeping mandate to...


Blog Entry
United Healthcare and Anthem Blue Cross Prior Authorization Updates

Both United Healthcare (UHC) and Anthem Blue Cross have announced changes to certain prior authorization requirements UHC Updates UHC now requires commercial to use eviCore national services to obtain prior authorization for proton beam therapy. Providers in the UHC Community Plan...


Blog Entry
Coding Corner: Coding for Radical Nephrectomy

What tissue is removed in a radical nephrectomy? The descriptor for CPT code 50545 always has caused confusion. The descriptor reads Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy) ...


Blog Entry
Reimbursement Updates: June 21, 2016

CMS Releases July 2016 ASC Payment System Updates The Centers for Medicare & Medicaid Services (CMS) released its July 2016 update to the ambulatory surgical center (ASC) payment system. The updates, which become effective as of July 1, 2016 and will be implemented starting on July...


Blog Entry
Practices Transition Smoothly to ICD-10; Updated Code Set Due This Summer

With the one-year anniversary of ICD-10 implementation and the deadline for the grace period for diagnosis specificity just a few months away, the majority of urology practices are reporting minimal issues with the transition to the new coding system. Data from the Centers for Medicare &...


Blog Entry
Coding Corner: Updates to Endoscopy Codes

Earlier this year, new Current Procedural Terminology (CPT) guidance was released to provide clearer guidance on how to code when performing endoscopic procedures (such as cystoscopy, urethroscopy and cystourethroscopy) on patients who have previously undergone reconstruction and urinary...


Blog Entry
Prior Authorization: What the AUA is Doing

Part three of this series outlines the steps that the AUA is taking to tackle the issue of prior authorizations. In August 2015, AUA shared its position statement on the Beers Criteria with six insurance companies. Each verified the importance of physician judgment and said the edits in...


Blog Entry
Retired Policies from CMS

If you work in a urology practice, it is highly likely that you have had to track down a local coverage determination (LCD) or commercial insurance policy, only to discover that you cannot find it. One of the reasons for this may be that the policy may have been retired. LCDs and...


Blog Entry
Prior Authorization and You: How Practices Manage the Strain

In part two of this three-part series, we explore how individual practices are managing the burden of prior authorizations. (See part one of the series here .) Prior authorization is just one of the many challenging and complex issues urology practices face each day. In a 2015 survey by ...


Blog Entry
New Prior Authorization Rules for BCN Network

Beginning July 5, 2016, prior authorization will be required on most testosterone products covered under the medical benefits for commercial members. Blue Care Network (BCN) of Michigan stated that, due to safety concerns, they are imposing a prior authorization requirement on most testosterone...