August 2012
The essential resource for your practice
Volume XXI, Number 8

SUI Measures Project Update

In July, the AUA, working with the American College of Obstetricians and Gynecologists (ACOG), submitted five proposed measures pertaining to stress urinary incontinence (SUI) to the National Quality Forum (NQF) as part of Stage 1 of its new endorsement pilot process.

Table of Contents


Coding Corner:

Register for the October Federal Regulation Seminar in Chicago

Recovery Auditor Prepayment Review Demonstration

The Centers for Medicare & Medicaid Services’ (CMS) Recovery Auditor (RA) prepayment review demonstration will begin on August 27, 2012, and end on August 26, 2015. It is applicable to seven fraud and error-prone states (FL, CA, MI, TX, NY, LA and IL) and four states with high volumes of inpatient stays (PA, OH, NC and MO).

This demonstration is not provider-based, as most demonstrations are; instead it is driven by Medicare Severity-Diagnosis Related Groups (MS-DRGs). Recovery Auditors will review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The claims will be chosen by CMS and will be reviewed for coding and medical necessity; and, at least initially, Recovery Auditors will review short-stay inpatient hospital claims (two days or less).

For The Record

The medical world has been slow to embrace the use of electronic health records (EHR). However, times have changed, and the medical community has come to understand the many benefits and security features of EHR. They have also been encouraged to implement a system by financial incentives, reductions in costs and improved outcomes accountability. To gain a better understanding of the current status of EHR implementation among urologists, we conducted a survey on the Practice Managers’ Network (PMN) listserv asking several questions pertaining to EHR usage.  The results show a dramatic increase in the number of urology practices that have implemented EHR.

Aetna Will Require Dual Certification/Accreditation for In-office Surgical Pathology Labs

Starting January 1, 2013, Aetna will require that practices offering in-office surgical pathology testing be certified with Clinical Laboratory Improvement Amendments (CLIA), as well as one of the following accrediting entities:

  • College of American Pathologists (CAP); 
  • American Osteopathic Association/HFAP; or
  • The Joint Commission. 

If the additional accreditation is not obtained, practices will not be reimbursed for the professional component of surgical pathology services billed in the Current Procedural Terminology (CPT) code range 88300-88314 and 88342. If these credentials are not obtained by January 1, 2013, laboratory services must be provided by Aetna in-network labs that include preferred laboratories Quest Diagnostics and AmeriPath.

The AUA believes that this new policy will create both a financial and administrative burden on physicians with in-office pathology labs. Furthermore, the requirement of dual certification/accreditation will do little to advance quality in these labs, as opposed to CLIA certification only.