July 2013
The essential resource for your practice
Volume XXI, Number 7

CMS Releases Proposed Rules, 2014 Medicare Changes

On July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2014 Medicare Physician Fee Schedule (MPFS) proposed rule (CMS-1600-P). The rule contains a number of important changes to urology, including changes the sustainable growth rate conversion factor.

There is an anticipated 24.4 percent decrease in the 2014 conversion factor. Every year there is a scheduled reduction in the sustainable growth rate (SGR) system. However, for more than a decade, Congress has acted to halt the reduction. The anticipated conversion factor (CF) for 2014 is $25.7109 as compared to the current 2013 CF of $34.0230.

Table of Contents


Coding Corner:

AUA Supports Rep. Roe in Urging Congressional Physicians to Preserve IOAE

AUA Continues to Advocate for Payment Reform

The AUA continues to advocate for payment reform on behalf of its members. On July 9, the association responded to a third legislative proposal to repeal the sustainable growth rate (SGR) with alternative payment models that mostly focus on the use of quality measures and registries in place of the SGR. The latest proposal and AUA comments responded to the House of Representative’s Energy and Commerce Committee’s legislative proposal.

 “We are working with other organizations to get Congress to repeal the sustainable growth rate formula for Medicare reimbursement. In addition, we are addressing the Centers for Medicare & Medicaid Services proposed rule on the 2014 physician fee schedule that includes a 24.4 percent proposed cut to physician reimbursement,” said AUA Health Policy Chair David F. Penson, MD, MPH. “While our activities focus on the larger issue of payment reform, we continue to address specific issues that are critical to our members. Examples of this activity include maintaining our ability to provide the full spectrum of services to our patients in our office, repealing the Independent Payment Advisory Board, and making sure we can participate in CMS quality programs such as the Physician Quality Reporting System through measure development.”

The AUA’s comments strongly support Congress’s overarching goal to promote a payment system that ensures payments for physician services are appropriate while also reducing unnecessary utilization, improving quality of care and easing the transition to a new payment model with a 5-year period of stability. Repealing the SGR is one of the AUA’s legislative priorities. At press time, the AUA has been informed that the House Energy & Commerce Committee is expected to introduce its SGR reform bill later this week, and that the bill could be marked up as early as next week. The AUA will continue to work with lawmakers and advocate on members’ behalf as the bill moves through the legislative process.

For The Record

More Than Half of Eligible Providers Achieve Meaningful Use of Electronic Health Records
30 percent of eligible AUA urologists have received Medicare incentives since 2011

In a press release issued on May 22, 2013, Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services (HHS) stated that at least 50% of eligible providers had “received Medicare or Medicaid incentive payments for adopting or meaningfully using electronic health records (EHRs).” Secretary Sebelius went on to say this was a goal set at the inception of the EHR incentive programs to be completed by the end of 2013.

GAO Releases Report on In-Office Pathology Services

Self-referring providers referred more anatomic pathology services on average than those who did not self-refer, according to a new report released July 15 by the U.S. Government Accountability Office (GAO).

The AUA, in concert with the Large Urology Group Practice Association has issued a response to the report.

The report cites increases in utilization by self-referring dermatologists, gastroenterologists, and urologists and makes the following recommendations to the Centers for Medicare & Medicaid Services:

  • Insert a self-referral flag on Medicare Part B claim forms and require providers to indicate whether pathology services are self-referred when billing Medicare;
  • Determine a means to ensure the appropriateness of biopsy procedures by self-referring providers;
  • Develop a payment approach for anatomic pathology services “that would limit financial incentives associated with referring a higher number of specimens – or anatomic pathology services – per biopsy procedure.