Practice Management

The American Medical Association has developed a kit that provides physicians and their office staff with a step-by-step approach to uncovering and appealing claims that have been inappropriately denied or underpaid by health plans.

Las Vegas--The Centers for Medicare & Medicaid Services istaking steps to lessen the burden that its policies create for physicians,according to two West Coast representatives of the agency. Physicians alsohave more influence on shaping health care policy, including the value ofservices, than they realize, said the officials, both physicians themselves.

The Centers for Medicare & Medicaid Services has adopted the National Provider Identifier (NPI) as the standard unique health identifier for health care providers to use in filing and processing health care claims and other transactions.

Q I am in a multiple-physician urology practice. One of our physiciansbelieves that billing 52332 with 52352 or 52353 with a ­59 modifiershould be paid, and that billing 52005 with 52332 with the ­59 modifiershould be paid (ie, 52005-59). When is it appropriate to use the ­59modifier?

The American Medical Association has issued a temporary code for reimbursement of online consultations between physicians and patients, Health Data Management reports.

Washington--The new Medicare reform bill, which for the first time providesa prescription drug benefit for Medicare recipients, comes with a hiddencost for physicians who administer chemotherapy drugs in their offices-andperhaps their patients.

Minneapolis--Surgeons and other physicians across the country continueto deal with the higher costs of practicing medicine in the face of decliningreimbursements. Those factors added up to lower profit margins for U.S.physician groups in 2002 and a continuing awareness of the need to pay attentionto all of the vagaries of the business of practicing medicine. For the mostpart, urologists showed little change in reimbursement.

Patients with nephrolithiasis frequently have metabolic abnormalities that promote calculus formation and, when identified and corrected, may attenuate stone activity.

Also, always use the ­59 modifier when inserting an indwelling stentduring ureteroscopy

Employees may work harder to achieve a bonus tied to reaching goals andobjectives

San Jose, CA?The Centers for Medicare and Medicaid Services has approved an application for assigning a new technology Ambulatory Payment Classification for photoselective vaporization of the prostate (PVP) to treat BPH.

Hartford, CT?A U.S. federal court has approved an agreement between insurance giant Aetna and representatives of nearly one million physicians.

Instructions for coding for all Evaluation and Management (E&M) services have several elements in common. One should always base documentation and coding on the amount of work required to provide good patient care.

The Centers for Medicare & Medicaid Services said it has updatedand improved its process for making Medicare coverage decisions. A noticepublished in the Federal Register on Sept. 26 incorporates lessons learnedover the past 3 years and implements certain requirements of the Medicare,Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000.

Many U.S. physician groups are experiencing losses in the midst of anincreasingly competitive and regulatory environment, according to a recentsurvey by the American Medical Group Association. Results for medical groupfinancial performance on a per-physician basis revealed that the averagegroup lost $3,977 per physician.

Separate proposed rule addresses overpayment of physician-administeredchemotherapy

Also, advice on billing for marker seeds and national figures for E&MservicesQ I work for two urologists. We have changed our schedule so thatone physician is always in the office when we administer leuprolide acetateinjections and perform uroflows, catheterizations, and other procedures.Who should charge for the service?

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.