Practice Management

A number of urologists have been implicated in two high-profile casesconcerning the illegal sale of drug samples. In this Urology Times SpecialReport, OIG attorneys outline several steps to take-and activities to avoid-tokeep you and your practice compliant with current regulations.

Physician must be immediately available, and the service must be performedby an employee

Although antibiotics are commonly used to treat symptoms of chronic pelvicpain syndrome, this approach is beneficial in a relatively small subsetof patients, and urologists must consider alternative treatment modalities,including physical therapy. In this exclusive Urology Times interview, JeannettePotts, MD, discusses current research and her own views on the diagnosisand treatment of chronic prostatitis. Dr. Potts is a member of the staffat the Cleveland Clinic Glickman Urological Institute. The interview wasconducted by Philip M. Hanno, MD, of the department of urology, Universityof Pennsylvania, Philadelphia.

FDA OKs treatment for men with testosterone deficiency. Livingston, NJ-The FDA has approved Columbia Laboratories' testosterone buccal system (Striant mucoadhesive) for testosterone replacement therapy. The transbuccal treatment is for men with conditions associated with a deficiency or absence of endogenous testosterone, including hypogonadism.

Q Can I be reimbursed for in-office injection of botulinum toxin inpatients with refractory overactive bladder? If so, how?

Wilmington, DE-The federal government will likely pursue urologistsin a second round of investigations surrounding the fraudulent marketingand sale of luteinizing hormone-releasing hormone agonists for prostatecancer. Just how far the probe will extend remains a source of debate amonglegal experts familiar with the case.

Up to 5% of Americans will be affected by stone disease over the courseof their lifetime. Despite major advances in shockwave lithotripsy and endoscopictechnologies, we must not underestimate the role of medical therapy in preventingstone recurrence. Two studies presented at the recent AUA annual meetingand reported in this issue of Urology Times (see page 10) offer valuablelessons on this aspect of stone management.

An important trend is emerging in the arena of practice management systems,and industry observers say urologists would be well advised to keep up todate on it.

Washington-As Congress moves toward possible approval of a new prescriptiondrug program for Medicare recipients later this summer, determination ofpayments for cancer drugs and therapeutic services may well hang in thebalance.

In a previous issue of Urology Times, this column discussed multiple procedures and the bundling edits for a single physician ("When to bill and not to bill for multiple procedures," May 2002, page 62). This article will address multiple procedures performed at the same encounter by two separate physicians.

Congress may want to cut provider payments to pay for parts of Medicarebill, Scully saysWashington-There are signs that House Republicans and the Bush administrationmay be preparing to pull out all the stops to pass medical liability insurancereform legislation this year as a way to placate physicians who face anotherprojected reduction in Medicare reimbursement levels next year.

AUA recommends 51798 any time ultrasound is performed to check for residualurineQ We use the BVI-3000 BladderScan from Diagnostic Ultrasound for residualurine. They show a shadow of amount left in the bladder on a printed report.Is this still considered a non-image? Is there any way we can use 76775using the BVI-3000?

The American Medical Association has recently taken a number of steps to support key physician causes and strengthen the organization internally.

There are two key elements to successful billing and collection-bothnow and in the future. The first is the accuracy of your documentation andcoding, basically the responsibility of the urologist. The second elementis the billing process, which can be computerized, automated, and performedby others.

Chicago-The Coalition for the Advancement of Prosthetic Urology (CAPU),fresh from its first battle in Washington earlier this year over reimbursementfor prosthetic urology devices and procedures, took another big step forwardwith a standing-room-only presentation at the AUA meeting here on Tuesday.

Chicago-Urologists interested in Medicare reimbursement rates for prostheticurology should consider attending an informational lunch hosted by the Coalitionfor the Advancement of Prosthetic Urology (CAPU). John Mulcahy, MD, chairmanof CAPU, which is comprised of leading clinical experts and researchersin prosthetic urology and the nation's leading manufacturers and developersof prosthetic urological devices, will discuss the group's advocacy andoutreach initiatives.

House approves national liability insurance bill; CMS outlines changesin Medicare

Reason for meeting attendance is just as important as keeping receiptsand records

Letters, appeals, and legal action can each help settle denial of compensationclaims

Societies can help with Medicare matters and with private insurance companies

Pharmaceutical manufacturers have long been under scrutiny for the methodsthey employ in marketing their products to physicians. Now, increasing concernthat drug makers are winning physician favor by deeply discounting chemotherapymedicines is placing those physicians under the microscopes of federal andstate authorities.

Only six states in the union have patient populations, physicians, and health care systems that are not suffering some degree of hardship caused by skyrocketing costs of medical liability insurance, according to the American Medical Association.

New codes established for catheterization and bladder ultrasound forresidual urine

Q How do I charge for a bladder scan for residual urine using thenew 2003 CPT code (51798 ) if I am using an "imaging" ultrasound?

Fee schedule will apply endoscopic reduction rules to cystoscopy andother CPT codes

As most urologists know, new federal standards have been established to ensure the privacy of patients' health information as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. In my September 2002 article, I presented limited information on HIPAA and its impact on physicians' practices, including the standards for the electronic transmission of health care transactions and the rules associated with implementation.

Denison, TX-A non-existent cap on non-economic medical liabilitydamages and the disproportionate number of high jury awards in the country'slargest state have physicians wondering if relief will ever come, even withlegislation in the works.

Philadelphia-The City of Brotherly Love has what many say is theleast friendly climate for physicians when it comes to medical liabilityinsurance. Insurance and reimbursement problems, however, are statewidephenomena in Pennsylvania. In Scranton, located in the northeastern cornerof the state, a seven-urologist group has said it will decide in Januarywhether to close.

Q. We see a lot of patients who are physicians and do not require themto pay co-pays. There are no enticements involved, but they do not haveany financial difficulties. At a seminar, I heard that you should collectthe co-pays but that you could choose not to collect the co-insurance. Therefore,should we start charging the physicians their co-pays?

But new rate schedule will reduce reimbursement for some drugs, devices,and procedures