Podcast
Urology Coding and Reimbursement Podcast
Hosted by Mark Painter, Scott Painter and Dr. Ray Painter · EN
The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.
40episodes
Episodes
Newest firstAll episodes
UCR 297: UTI PCR Coding Changes, Audit Risk, and the 2027 RVU Winners and Losers
4d ago00:35:41Tap to summarizeJuly 24, 2026In this episode, Scott, Mark, and Dr. Ray Painter examine a major shift in Medicare’s approach to coding UTI PCR testing. The discussion explains why reimbursement may now depend on the number of testing kits, methodologies, or procedures used—not simply the number of organisms reported—and what practices should review with their laboratory partners. The team also addresses denials, RAC and UPIC audits, corrected claims, potential commercial payer takebacks, and the continuing uncertainty in MolDX states. They then review the proposed 2027 RVU changes affecting urology, including a significant increase for in-office bulking agent injections, potential reductions for urodynamics, and additional changes to prostate biopsy codes. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 296: 2027 Medicare Proposed Rule – The Changes That Matter Most to Urology
2w ago00:37:07Tap to summarizeJuly 17, 2026In this episode, Scott and Mark Painter provide their initial analysis of CMS's proposed 2027 Medicare Physician Fee Schedule and highlight the changes most likely to impact urology practices. The discussion covers the proposed conversion factor reduction, a significant new proposal to apply the multiple procedure payment reduction to E/M services billed with modifier 25, changes to G2211, updates to practice expense methodology, prostate biopsy coding revisions, telehealth proposals, and a substantial reimbursement increase for bulking agent injections. The team also shares practical insight into what these proposals could mean for physician compensation, practice operations, and future commercial payer policies. The key takeaway: while the rule is still only proposed, now is the time for urology practices to understand the changes, submit meaningful comments, and begin planning for what could be a very different reimbursement landscape in 2027. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 295: New Kidney Stone Scope and Sheath Facility Payments – What Every Urologist Needs to Know
3w ago00:40:09Tap to summarizeJuly 10, 2026In this episode, Scott, Mark, and Dr. Ray Painter break down CMS’s latest updates to facility reimbursement for kidney stone procedures, including the revised C9761 code, the new C8014 code, and the payment implications for hospitals and ambulatory surgery centers. The discussion explains how suction-integrated ureteroscopes and suction-enabled access sheaths are now reimbursed, why physicians should understand facility payment even though their professional fee does not change, and how these updates may influence conversations with hospitals and ASCs about adopting new technology. The team also reviews the proposed 2027 payment changes and emphasizes the importance of aligning clinical decision-making with facility economics to expand patient access to innovative stone treatment technologies. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 294: Buy-and-Bill Drugs in Urology – Protecting Your Practice from Costly Mistakes
4w ago00:31:58Tap to summarizeJune 26, 2026In this episode, Scott, Mark, and Dr. Ray Painter continue their discussion on buy-and-bill drugs, using ZUSDURI® as a case study to explore the clinical, operational, and reimbursement challenges facing urology practices. The conversation covers prior authorizations, payer eligibility checks, documentation requirements, medical record reviews, RAC audits, and strategies for successfully introducing new drug therapies into a practice. The team also discusses the importance of standardized protocols, staff training, monitoring reimbursement, and leveraging technology to reduce financial risk. The key takeaway: successful buy-and-bill programs depend on more than getting paid—they require the right processes to ensure practices get paid, keep the payment, and continue delivering innovative therapies to patients. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 293: Unprocessable Claims, Timely Filing Denials, and Urodynamics Global Billing
Jun 2000:26:52Tap to summarizeJune 19, 2026In this episode, Scott, Mark, and Dr. Ray Painter tackle three challenging reimbursement scenarios submitted by listeners: Medicare denials for category III code 0816T, handling patient payments when claims are denied for timely filing or missing prior authorizations, and the ongoing complexities of billing urodynamics studies in a group practice setting. The discussion explores why “unprocessable” claims often require deeper investigation, how payer contracts influence whether patient payments must be refunded, and the pros and cons of global versus split billing for urodynamics services. The key takeaway: many reimbursement problems are not coding issues at all—they are workflow, contract, and claim-processing issues that require practices to understand both the rules and the business side of medicine. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 292: Downcoding, Record Requests, and Takebacks — Fighting Back Against Payer Tactics
Jun 1200:32:04Tap to summarizeJune 12, 2026In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose discuss the growing wave of payer scrutiny impacting urology practices, including automatic E/M downcoding, stealth denials, medical record requests, takebacks, and RAC-style reviews. Drawing on real-world experiences from hundreds of recently identified downcoded claims, the team shares practical strategies for detecting reimbursement issues before appeal deadlines expire, prioritizing revenue cycle resources, and building processes to monitor payer behavior more effectively. The discussion emphasizes the importance of strong clinical documentation, payer audits, contract monitoring, and team-wide coordination. The key takeaway: clean claims are no longer enough—practices must actively monitor, audit, appeal, and defend their reimbursement to avoid losing revenue. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 291: C9761 Update, Intraoperative Consults, and Office-Based Procedure Challenges
Jun 500:35:51Tap to summarizeJune 5, 2026In this episode, Scott, Mark, and Dr. Ray Painter provide an important update on the evolving C9761 reimbursement landscape, including CMS’s decision to revise the code description and introduce a new HCPCS code for suction-enabled ureteral access sheaths. The discussion explores what these changes could mean for ASCs, HOPDs, and physicians involved in stone management. The team also answers listener questions about billing intraoperative consultations versus procedures and addresses payer denials related to place-of-service restrictions when procedures are performed in the office setting. The key takeaway: understanding documentation requirements, reimbursement rules, and site-of-service limitations is essential as coding and payment policies continue to evolve. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 290: Stent Removal Clarifications, PAE RAC Audits, and Prostate Biopsy MUEs
May 2200:31:12Tap to summarizeMay 22, 2026In this episode, Scott, Mark, and Dr. Ray Painter revisit ureteral stent removal and replacement coding after listener feedback highlighted the need for additional clarification on when cystoscopic codes versus fluoroscopic exchange codes apply. The discussion then shifts to emerging RAC audits targeting prostate artery embolization (PAE) claims involving CPT codes 37242 and 37243, emphasizing the importance of detailed documentation and medical necessity support. The episode wraps with a deep dive into Medicare’s medically unlikely edit (MUE) for add-on code 55715 for additional prostate biopsy lesions—exploring why the edit conflicts with CPT guidance, how practices should report multiple lesions, and why appeals may be necessary to receive proper reimbursement. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 289: Live from the AUA – Innovation, New Technology, and the Reimbursement Challenge
May 1600:19:50Tap to summarizeMay 15, 2026In this special live episode from the AUA Annual Meeting in Washington, D.C., Scott, Mark, and Ray Painter share highlights from the AUA Innovation Nexus program, where emerging companies, investors, and industry leaders are working to bring new urology technologies to market . The discussion focuses on the growing importance of reimbursement strategy early in product development, the operational and financial realities practices must consider before adopting new technology, and why collaboration between innovators, physicians, and practice teams is critical for success. The episode also explores how efficiency, workflow, and return on investment increasingly drive whether promising technologies ultimately make it into everyday urology practice. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
Transcribe →UCR 288: New Technology in Urology – Don’t Let Reimbursement Be an Afterthought
May 800:21:49Tap to summarizeMay 8, 2026In this episode, Scott, Mark, and Dr. Ray Painter discuss the growing wave of innovation in urology and why reimbursement strategy must be part of the conversation from day one. Ahead of the AUA Innovation Nexus meeting in Washington, D.C., the team explores how new technologies move from concept to clinical adoption—and the reimbursement hurdles that can slow that process down. The discussion covers coding, coverage, payer adoption, workflow planning, AI-driven practice tools, and the importance of building a realistic business plan before introducing new technology into a practice. The key takeaway: exciting technology alone is not enough—successful adoption requires clinical value, operational readiness, and a clear reimbursement strategy. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/
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