January 2011
The essential resource for your practice
Volume XXI, Number 1

CMS Releases Final Medicare Physician Fee Schedule Rule

@blurbendThe Centers for Medicare & Medicaid Services (CMS) displayed the Final CY 2011 Medicare Physician Fee Schedule Rule (link removed) on its Web site on November 2, 2011. At press time, AUA staff was analyzing the rule and preparing comments, which were due by January 2, 2011.

Certain important provisions of the rule are summarized below.

  • CMS has finalized the proposed extension of the imaging multiple procedure payment reduction (MPPR) to non-contiguous body parts and multiple modalities provided to the same patient in the same session (CT, MRI and ultrasound). The AUA opposed this proposed policy. Under the Affordable Care Act of 2010 (ACA) provision, full payment is made for the technical component of the most expensive procedure. The technical component will be reduced by 50 percent for second and subsequent imaging procedures of contiguous or non-contiguous body parts in same or different imaging modalities.
  • CMS adopted some of the changes the AUA recommended to the physician disclosure of self-referred imaging provisions required under healthcare reform. These include: reducing the number of alternate suppliers that must be identified on the disclosure notice from 10 to five (within 25 miles of the referring physician); removing the requirement that the alternate suppliers’ distance from the referring physician’s office be listed in the notice; and removing the requirement that the referring physician obtain the patient’s signature on the notice and retain a copy of the disclosure in the patient’s medical record.
  • At press time, the impact of the final rule on urology is projected to be a 3 percent cut in relative values. The final impact includes a 1 percent cut in work and malpractice relative value units (RVUs) attributed to cuts in code values, a 3 percent cut in practice expense due to transition to the new physician practice information survey (PPIS) system, increased equipment use rate for advanced imaging and the multiple procedure payment reduction (MPPR) expansion, and a 1 percent increase in relative value units (RVUs) due to rebasing of the Medicare Economic Index (MEI).
  • The ACA directed the Secretary of the U.S. Department of Health and Human Services (HHS) to specifically examine potentially misvalued services in seven categories, codifying in law an already existing practice by CMS when evaluating recommendations from the Relative Value Scale Update Committee (RUC), which are:
  1. Codes and code families for which there has been the fastest growth,
  2. Codes or families that have experienced substantial changes in practice expenses,
  3. Recently established codes for new technologies or services,
  4. Multiple codes that are frequently billed in conjunction with furnishing a single service,
  5. Codes with low relative values, particularly those that are billed multiple times in a single treatment,
  6. Codes that have not been subject to review since implementation of the Resource-Based Relative Value Scale (RBRVS) [i.e., so-called Harvard valued codes], and
  7. Other codes determined to be appropriate by the Secretary.

For the last category, CMS proposed looking at codes with site-of-service anomalies and those that qualify as 23-hour stay codes. In the proposed rule, CMS asked the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) to review the values of many codes falling in the seven categories. CMS also targeted key codes—called multispecialty points of comparison (MPC) services—that the AMA RUC uses as reference for valuing other services.

  • In light of overwhelming negative comments, including those by the AUA and Alliance of Specialty Medicine, CMS decided not to change the methodology for revaluing codes with site-of-service anomalies. Many urology codes were included in the targeted services with site-of-service anomalies and the AUA sees this decision as a victory. CMS will continue to use the RUC recommended values for these codes in CY 2011 as interim final values and is asking the RUC to review and revise the building blocks of the codes so that new valuations can be determined for CY 2012.
  • CMS finalized its proposed approach to valuing 23-hour stay services by decreasing the hospital discharge day management service from one day to a half-day, deducting the RVUs of inpatient hospital visits from the starting RVU value and reallocating the time associated with the intra-service portion of the subsequent hospital care visits (or observation care visits).
  •  The ACA also instructed the Secretary to establish a formal process to validate relative values under the fee schedule, including work elements and pre-, post- and intra-service components of work. CMS solicited public comment on approaches to validation, including use of time and motion studies. The AUA commented that we do not feel there are viable alternative methods for validating physician time and intensity that will preserve the relativity of physician services, which is foundational for the RBRVS and we continue to support the RUC process which has improved continuously since its inception in 1992. Many commenters echoed our statement. CMS responded in the final rule that they intend to establish a more extensive validation process of RVUs in the future in accordance with the provisions in the ACA. The new process will be discussed in future proposed physician fee schedule rules.
  • The AMA RUC provided work RVU recommendations to CMS for 291 Current Procedural Terminology (CPT®) codes. CMS accepted 207 (71 percent) of the recommendations and provided alternative values for the remaining 84 (29 percent) codes. CMS disagreed with RUC work value recommendations for two urology codes:
  1. 52281 cystoscopy and treatment: RUC recommendation 2.8, CMS adopted 2.6
  2. 52332 cystoscopy and treatment: RUC recommendation 2.83, CMS adopted 1.47

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Table of Contents


Coding Corner:

Modifier JW: Does This Apply to My Office?

AUA Health Policy Division Year in Review

2010 was a banner year for the AUA Health Policy Division. We celebrated success on a number of key fronts — from the introduction of urology specific legislation on Capitol Hill, to UROPAC’s reaching its $1 million fundraising goal, to ensuring that urology’s voice was heard at the quality table. Additionally, our team worked diligently to ensure fair compensation for our members’ work, and to provide AUA members with top-notch practice management services and both new and updated clinical practice guidance. As we look forward to 2011, we are confident that we will continue to succeed in helping AUA members provide quality patient care while at the same time maintaining their practices in the midst of healthcare reform implementation. Read on for full Year in Review summaries of the AUA Government Relations & Advocacy, Guidelines, Practice Management, Quality, and Reimbursement & Regulation departments.

-Beth Kosiak, PhD, AUA Associate Executive Director of Health Policy@blurbend


For The Record

Urology Practices Receive 2009 E-Rx and PQRI Incentive Payments

Subscribers to the AUA Practice Managers’ Network noted that they have begun receiving bonus checks from Medicare contractors@blurbend for successful participation in the Medicare Electronic Prescription program (E-Rx) and the Physician Quality Reporting Initiative Program (PQRI) for calendar year 2009. A number of questions have arisen, which will hopefully be answered when the feedback reports are published by Medicare in November 2010. Such questions include:

Since both incentive bonuses are 2 percent of Medicare allowables, shouldn’t both checks received by our practice be the same?
The requirements for both E-Rx and for PQRI are different and they are both measured per national provider identifier (NPI). So if you are in a solo practice, the odds are your E-Rx and PQRI could be the same. However, if you are in a group practice, all may have qualified for E-Rx incentives but only a few may have achieved the success rates for PQRI incentives. You will be able to determine this after reviewing your feedback report.

How can I get my feedback reports?
There are two ways to get feedback reports:

  • The first is through the Centers for Medicare & Medicaid Services (CMS) IACS (short for Individuals Authorized Access to the CMS Computer Services) secure portal. Note: this is very cumbersome and filled with security hurdles; so unless you have more than 20 providers who participated in E-Rx or PQRI, we recommend choosing Option 2 below.
  • Call your Carrier/Medicare Administrative Contractor (MAC) Provider Contact Center and request a confidential feedback report for each individual NPI number in your practice. They will log your request and will send each physician an e-mail with this information. So you may have to give different e-mail addresses for each physician. However, you should ask if you can provide one e-mail address for all participants in your practice because it will make it easier to track.

CMS offers a user guide to assist you with the E-Rx feedback report and a user guide for the PQRI feedback report.

The AUA Practice Management Department is requesting copies of feedback reports from all subscribers in order to develop educational materials on improving PQRI and E-Rx scores next year. To share your information, contact pracman@AUAnet.org.

AUA and MGMA Conduct Webinar on Meaningful Use Quality Reporting

On November 17, 2010, the AUA Practice Management Department, in collaboration with the Medical Group Management Association’s (MGMA) Urology Administration Assembly, held a Webinar, titled Adapting Your Urology Practice’s Quality Measurement and Reporting to Meaningful Use. Faculty for this presentation was Rosemarie Nelson, an electronic health records (EHR) expert from the MGMA Consulting Group, and AUA Director of Practice Management Rick Rutherford. The Webinar included an overview of the Meaningful Use (MU) requirements that would allow urology practices to earn the federal subsidies payable beginning in 2011. Following the overview, there was an in-depth discussion of the quality reporting measurement and reporting process included in the MU program and how a certified EHR system can record the necessary data and aid the providers in submitting attestation that they have complied with these requirements under MU Stage 1. The recorded version of this Webinar can be purchased from the MGMA Web site.

The AUA Health Policy Brief Moves Online

As you know, starting this month, the AUA Health Policy Brief has been transitioned into an interactive e-newsletter. This new format offers you an expanded, robust online archive of top health policy stories relating to urology, as well as single-click access to key information, including Medicare regulations, news releases and legislation.@blurbend Using this new format, you will also be able to link directly to AUA Action Alerts, the UROPAC Web site, CMS reports, FDA alerts, AUA comment letters and the other online resources that we cover in the Health Policy Brief.