CMS fails to use AUA data in practice expense RVU update

Mar 01, 2006

Washington--When 2006 began, there was somewhat of a mess in Washington involving Medicare reimbursement, and that was especially true for urologists. At press time, some of those issues were being resolved, but, even so, there will likely be fallout that will at least inconvenience urologists and their staffs.

Before Congress' year-end recess in December, lawmakers failed to give final approval to the Deficit Reduction Act of 2005, which implements the 2006 federal budget and rescinds a 4.4% reduction in overall Medicare payment levels. That meant that new rates, including the cuts, went into effect Jan. 1.

However, on Feb. 2, the House gave final approval to that budget bill for 2006, which is designed to save nearly $40 billion over 5 years by imposing cuts in many domestic programs, including Medicaid. President Bush signed the measure on Feb. 8.

The Medicare payment fiasco began late last year when the House and Senate passed differing versions of the Deficit Reduction Act. In order to avert the 4.4% Medicare payment cut, Congress had to reconcile differences in the final versions and pass a compromise version of the bill, which then went to President Bush for his signature.

On Jan. 3, AUA officials sent a pointed letter to CMS Administrator Mark McClellan, MD, PhD, saying it was "extremely disappointed" that CMS did not use AUA's supplemental practice expense survey information to update the 2006 practice expense RVUs for all procedures performed by urologists.

Signed by AUA President Joseph N. Corriere, Jr, MD, and Health Policy Council Chair James B. Regan, MD, the letter noted that CMS used AUA data to update RVUs for urology drug administration, but had failed to reflect updated calculations in its documentation. The letter urged CMS to publish a correction as soon as possible, and to make the changes retroactive to Jan. 1.

"We also strongly object to the reasoning that CMS withdrew its practice expense proposals in the final rule in part due to a calculation error that caused almost all the practice expense RVUs published in the Aug. 8, 2005, proposed rule to be incorrect," AUA declared, adding that "...urologists are paying for CMS's error through the loss of practice expense payments rightfully due them."

"Nevertheless, it is unfair and inequitable that implementation of our survey data has been delayed and that we are forced to go through an entirely different process than [do] groups who had supplemental survey data accepted prior to 2006," AUA officials wrote in their letter.

CAP confusion

Regarding the CAP drug issue, current CMS policy means that carriers will only pay for the less-expensive drug, goserelin (using code J9202), even when physicians bill for leuprolide (code J9217).