June 26, 2026

In 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 Hub

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Botox LCD Alert

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering 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/joinuptp

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The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/

June 19, 2026

In 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 Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering 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/joinuptp

Click 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/

June 12, 2026

In 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 Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering 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/joinuptp

Click 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/