The American Urological Association’s (AUA’s) Reimbursement and Regulation Department tracks key regulatory developments that affect urology and organized medicine and ensures that we provide convincing and well-supported comments to those federal agencies responsible for issuing and implementing the regulations in question. Additionally, we monitor, research and address reimbursement policies and challenges from public and private payors; our private insurer outreach initiative, where AUA physician leadership and professional staff meet with the national medical directors and senior leadership of private insurance companies, ensures that there is an effective dialogue to identify and resolve problems proactively on behalf of our members. The Department also has primary responsibility for the creation of new CPT codes and modification of existing ones through its work on American Medical Association (AMA) CPT Editorial Panel-sponsored national committees, and reviews valuations for new or existing CPT codes through the AMA/Specialty Society Relative Value Scale Update Committee (RUC), in which both seasoned volunteer urologists and experienced AUA staff participate.
The Department works with two volunteer groups: the Coding and Reimbursement Committee (CRC) and the National Insurer Advisory (NIA) Workgroup. The CRC serves as urology's representative in the area of coding and terminology development. They seek new and updated codes to ensure accurate identification of urologic diseases and procedures. Additionally, selected committee members represent the AUA before the AMA CPT Editorial Panel and the RUC. The NIA Workgroup (formerly known as the National Carrier Advisory Workgroup) focuses on Medicare and private insurance issues. The Workgroup, composed of representatives appointed by the appropriate Medicare contractor/carrier through recommendations of the state urology society, identifies problems encountered across the United States with these carriers and works with AUA staff to correct any issues associated with coverage determinations or other policy problems.
Learn more about AUA regulatory/policy advocacy.