Practice Management

Washington—Officials at the Centers for Medicare & Medicaid Services have recommended that several urologic procedures be ineligible for reimbursement if they are performed in ambulatory surgical centers.

Physical therapy, perineural injections may provide relief without surgery, experts say

Will leuprolide acetate (Lupron) reimbursement fall by 20% in 2005? When will it take place? And what will the reimbursement be?

Washington--There's an outside chance that urologists tired of fighting for medical liability reform in efforts to reduce their insurance rates could end up benefiting from the work of a surgeon who became a politician and is determined to get some federal judges confirmed by Congress.

The year 2005 will portend a significant decrease in income for nearly every American urologist. Most will be impacted by Medicare's slashing the reimbursement for LHRH agonists and certain other drugs administered in the office. Solo practitioners can anticipate annual losses of income in the thousands of dollars, and larger group practices can expect over a $1 million shortfall this year.

Creating a fully automated office costs a significant amount of money and required a lot of time and hard work. For our practice, it was worth it.

Nearly three-fourths of urologists said they wished they had more time to practice medicine.

Washington--The Centers for Medicare & Medicaid Services has published its final rule implementing the 2005 Medicare fee schedule, and it's not good news for urologists-especially those who administer cancer drugs in their offices.

Raritan, NJ-The FDA has approved a once-a-day liquid formulation of the fluoroquinone antibiotic levofloxacin (Levaquin), from Ortho-McNeil Pharmaceutical, Inc. Levofloxacin is indicated for the treatment of a number of infections, including complicated and uncomplicated urinary tract infections, chronic bacterial prostatitis, and acute pyelonephritis.

San Diego--Searching for ways to recoup lost revenue from outpatient prostate cancer therapy, urologists have turned to a variety of non-traditional income producers, ranging from CT scanning to processing of biopsy specimens.

Reimbursement for urologic evaluation and management services increased by one-half since 1995, while surgical reimbursement rates have decreased by about one-third, according to a study in the November Journal of Urology (2004; 172:1958-62).

The Centers for Medicare & Medicaid Services said it has made "significant" changes in Medicare's approach to paying for drugs administered in the physician's office that will allow increased coverage in 2005 for both the drugs and their administration.

Washington-The results of this month's presidential and congressional elections will go a long way toward determining the fate of efforts to curb medical liability lawsuits and judgments, as well as the related issue of protecting patient safety.

You collect your money at the time of service, and you have no accounts receivable for Medicare patients.

Three separate coding and reimbursement issues are impacting urologists now and will continue to affect practices in 2005. This article will focus on these three issues-ICD-9 changes for 2005, drugs purchased by physicians, and the -59 modifier.

Bladder ultrasound is noninvasive and relatively easy to perform, which may explain its increased usage in recent years. However, the American Board of Urology has expressed concern that urologists may be overusing the test. In this exclusive Urology Times interview, Pat Fulgham, MD, president of Urology Clinics of North Texas, Dallas, discusses data on the dramatic shift in bladder ultrasound usage by some urologists. Dr. Fulgham, who teaches an annual AUA course on ultrasound, also discusses clinical and reimbursement guidelines clinicians should follow. The interview was conducted by UT Editorial Consultant Robert C. Flanigan, MD, professor and chairman of the department of urology, Loyola University Medical Center, Maywood, IL.

Computer labels withstandchemicals, extreme temps

Cross training is good for the physician, because it provides more flexibility in managing the efficiency of the practice when employees are absent.

Washington--Even though the new Medicare physician fee schedule rule increases physician payments by 1.5% overall for Medicare services, urologists are facing a 13% reduction, according to AUA officials.

Q A pediatric urologist I code for is concerned that we cannot bill/code for both orchiopexy and a hernia repair done during the same operating room session. Do you have any documentation on this matter? When you look up 54640 in CPT 2004, it references, "For inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525." In the Medicare Correct Coding Guidelines, I do not see any edits stating not to bill both procedures together.

The American Medical Association has updated its Model Managed Care Contract to reflect recent legal and other changes. New portions of the model contract, now in its third edition, address changes in medical necessity, HIPAA regulations, and prompt payment.

CMS estimates that Medicare payments to urologists will decrease 13% in 2005.

The procedure should be of a durationand complexity that will permit the patient to recover and be discharged.

Minnetonka, MN-The FDA has cleared for marketing American Medical Systems' 700 Tactile Pump, the latest addition to the AMS 700 line of penile prostheses.

Minnetonka, MN-The FDA has cleared for marketing American Medical Systems' 700 Tactile Pump, the latest addition to the AMS 700 line of penile prostheses.

Only by qualifying for a special modifier would a procedure be 'pulled' from the global

CMS clarification emphasizes medical necessity as 'overarching' criterion for payment

The American Society of Clinical Oncology has submitted a series of proposals to an AMA workgroup aimed at changing a number of CPT codes for infused drugs.

You know how important it is to offer competitive salaries and benefits. The trick is figuring out how much is enough.

Settlements create monetary funds, prevent companies from engaging in harmful practices