June 2013
The essential resource for your practice
Volume XXI, Number 6

CMS: Part B Drugs Not Exempted from Sequestration Cuts

In a response to lawmakers seeking to clarify how sequestration will affect payments for the delivery of oncology drugs, the Centers for Medicare & Medicaid Services (CMS) has stated that Part B drugs will not be exempted from sequestration cuts. The statement was made in a letter responding to lawmakers requesting clarification on how sequestration would affect these services.

Table of Contents


Coding Corner:

Reimbursement Alerts for Practices

SGR Repeal Activity Heats Up on Capitol Hill; AUA Works with Lawmakers

The House of Representatives Ways and Means (W&M) and Energy and Commerce (E&C) committees have renewed cooperative efforts to formulate a “doc fix” to the current sustainable growth rate (SGR) payment formula, according to public statements made by committee chairs Rep. Fred Upton (R-MI) and Dave Camp (R-MI). Reps. Upton and Camp have indicated that they hope to have a proposal ready prior to the 2013 August recess.

In recent weeks, the AUA has (both independently and in concert with the Alliance of Specialty Medicine) been working actively to provide both House committees with necessary feedback and comments regarding SGR repeal. Additionally, the AUA met with W&M Health Subcommittee Chair Kevin Brady (R-TX-8) to discuss our concerns and also held meetings with Republican members of the E&C Committee to discuss proposed legislation to repeal and replace the SGR. Late last month, the AUA provided a formal response to the Senate Finance Committee’s request for input on policies affecting the physician fee schedule and the fee-for-service system.

Physician payment system reform was a key topic at the 2013 Joint Advocacy Conference earlier this year, with lawmakers optimistic for change during the 113th Congress. However, even as many agree that reform is necessary, a major challenge that remains is identifying the “pay for” to offset the costs of repealing the SGR system and how such change will be implemented.

The AUA strongly supports 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.

FDA Approves of Radium-223 for Metastatic Castration-Resistant Prostate Cancer

On May 15, 2013, the U.S. Food and Drug Administration (FDA) approved Radium-223 dichloride to treat men with symptomatic metastatic castration-resistant prostate cancer (mCRPC )that has spread to bones but not to other organs.

AUA Responds to Draft EPA Report on Radiation Protection for Diagnostic, Interventional X-ray

Comments call for removal of unsubstantiated claims on physician self-referral

The American Urological Association (AUA) has provided comments on a new guidance document from the Environmental Protection Agency (EPA), calling for the group to review and remove a section on self-referral. The document, Federal Guidance Report No. 14, “Radiation Protection Guidance for Diagnostic and Interventional X-Ray Procedures,” was released in April for public comment. This document was the EPA’s first update on the medical use of radiation protection programs since October 1976. The recommendations contained in the report represent consensus judgment of an interagency Medical Work Group for the practice of diagnostic and interventional imaging by federal agencies.