Practice Management

Replacing office visits with virtual visits may become the new normal, writes Robert A. Dowling, MD.

"CMS has clarified that it will not enforce the requirement that remote services be reported only for patients with whom the physician has a prior relationship, allowing you to provide new patient visits remotely (99201-99205)," write Jonathan Rubenstein, MD, and Mark Painter.

"Many companies understand your utilization, payment, and prescribing data much more thoroughly than you might think," writes Robert A. Dowling, MD.

Avoid making decisions motivated by emotion and fear, advises Jeff Witz, CFP.

"A 90-day global procedure means that the work for the procedure and associated care has already been factored into the payment for the code, typically including 1 day preoperative work, work on the day of the procedure, and the work that is typical for 90 days beginning the day after surgery," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter answer the question: Our urologists are incorporating Botox injections into urethral strictures after a direct vision internal urethrotomy. How do you appropriately code for the Botox injection into the stricture?

"As we see it, the indication to perform this procedure was that the stone was in the ureter. The fact that it was accidentally knocked back into the kidney is inconsequential," write Jonathan Rubenstein, MD, and Mark Painter.

"An excess contribution into a Roth IRA can be a hassle, but it is correctible. The sooner you fix the error, the less painful and less expensive the process will be," writes Jeff Witz, CFP.

The developer of a leading telemedicine platform and a health care staffing agency have teamed up in a pilot program to provide clinical and emergency tele-urology services across the United States.

"First... you have to determine if you are in a global period," write Jonathan Rubenstein, MD, and Mark Painter.

"Ignoring the entire Quality category may be a risky strategy in 2020 and beyond," warns Robert A. Dowling, MD.

"Category III codes are designated as temporary codes by the AMA. Even though the codes are considered temporary, they are an integral and important part of the system," write Jonathan Rubenstein, MD, and Mark Painter.

"Contribution limits increased for 401(k)s, 403(b)s, and most 457 plans to $19,500, up from $19,000 in 2019," writes Jeff Witz, CFP.

Jonathan Rubenstein, MD, and Mark Painter address the coding question: My local hospital tells me that starting Jan. 1, 2020, I have to consult a Clinical Decision Support Mechanism due to the Appropriate Use Criteria program. I thought that didn’t start until 2021. Can you help?

"The mean and median MIPS final composite scores among urologists in 2017 were 79.3 and 91.2, respectively; this was slightly higher than all specialties combined," writes Robert A. Dowling, MD.

I wanted to take this opportunity to say thank you to all who have read my “Coding and Reimbursement” and “Coding Q&A” articles for the past 23 years.

"By creating time-based codes, one can most accurately describe and be reimbursed for the amount of time and effort spent face to face with an individual patient," writes Jonathan Rubenstein, MD, and Mark Painter.

"If you are self-employed, a solo 401(k) is an excellent option for saving for retirement," writes Jeff Witz, CFP.

“It’s actually an exciting time for patients who have metastatic urothelial cancers and prostate cancers or advanced prostate cancers because there are a lot more products on the way, like the newer hormone agents for prostate cancer and the new immunologic agents like PARP inhibitors for different types of cancers," says one urologist.

Declining reimbursement for their work and the burden of prior authorization are nearly universal concerns of U.S. urologists, an exclusive Urology Times survey has found.

Urology will make a modest gain overall in the 2020 final rule for the Medicare Physician Fee Schedule, although the truly significant changes won’t be felt until 2021.

"Becoming a member of the larger group has given us more bargaining power in the health care marketplace, so we’ve been able to get better health care, not only for us but for our staff," says one urologist.

"If the specific time spent discussing the disease and the appropriate treatment was not documented, then be sure that your documentation meets the criteria (history, physical examination, and medical decision-making) separate from any criteria performed to make sure the patient was prepared and able to have the procedure," write the Painters.

"On Nov. 1, 2019, CMS published a final rule making important changes to the 2020 Quality Payment Program (Merit-based incentive Payment System [MIPS] and alternative payment models). Among the most significant are changes to the MIPS Cost Category: changes in the way patients are attributed to physicians, changes in the way the cost measures are calculated, and the addition of new episode-based cost measures," writes Robert A. Dowling, MD.

Avenues for taking distributions vary according to the decedent’s age.

"Automated urinalysis codes declined 19%, while the manual urinalysis codes without and with microscopy dropped 0.6% and 7.6% respectively over the 3-year period," writes Robert A. Dowling, MD.

"One of the common issues we have noted for urology practices in updating ICD-10 codes is not the electronic medical record or practice management system failing to load new codes; rather, it is a failure to update templates," write Ray Painter, MD, and Mark Painter.

In this video, Mara R. Holton, MD, vice chair of LUGPA’s Health Policy Committee, discusses how the 2020 Medicare Physician Fee Schedule Final Rule will affect urologists.

"This time of year presents the perfect opportunity to review and possibly adjust your financial planning strategies," writes Jeff Witz, CFP.

"There are two major reasons for you to confirm accuracy: to be sure that fraudulent claims are not being submitted and to confirm that the claims accurately reflect the work you have performed," write Ray Painter, MD, and Mark Painter.