The US Food and Drug Administration (FDA) has approved Xofigo (radium Ra 223 dichloride) to treat men with symptomatic late-stage (metastatic) castration-resistant prostate cancer that has spread to bones but not to other organs. It is intended for men whose cancer has spread after receiving medical or surgical therapy to lower testosterone.
At the American Urological Asso­ciation’s annual meeting, recognized medical compliance expert Sean Weiss, CPMA, CPC, CPC-P, CCP-P, ACS-EM, Chief Compliance Officer for DoctorsManagement in Knoxville, Tennessee, offered urologists and urology practice managers tips on how to avoid audits or—if luck turns the other way—how to survive them.
Medical necessity is defined as “healthcare services or products that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or its symptoms (American Medical Association, Policy H-320[3], AMA Policy Compendium).”
The Centers for Medicare & Medicaid Services (CMS) seeks to limit the scope of in-office ancillary services. At the American Urological Association (AUA)’s annual meeting, Julie E. Kass, JD, Principal of Ober|Kaler’s Health Law Group in Washington, DC, whose practice deals with regulatory aspects of the Stark law and the federal Anti-Kickback Statute, described such services as advanced imaging (eg, computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET] scans), anatomic pathology, radiation oncology, and lithotripsy.
At the American Urological Association’s annual meeting, Jamie Verkamp, Managing Partner and Chief Speaking Officer at (e)Merge, Kansas City, Missouri, noted that problems within organizations occur when leadership and the teams under them fail to work as cohesive units, particularly when leadership is unfit or unprepared for the job. She warned that even the right person in the wrong role can become a management pitfall, and one in which the office environment ceases to be productive. The current changes in healthcare provide challenges to organizations and require teamwork to prevent a derailer.
The following sections will assist healthcare professionals and payers by providing appropriate coding and billing information associated with the treatment of prostate cancer.

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