Urology A/R recovery
Urology A/R ages around in-office drug administration (buy-and-bill hormone therapy and intravesical agents billed by J-code, NDC, and units), prior authorizations for lithotripsy, prostate biopsy, and minimally invasive BPH procedures, bundling edits on cystoscopy and urodynamics, and pathology claims that depend on the procedure. MARR Partners works these 90+ day claims for urology practices on a contingency fee.
Why urology A/R ages
Urology practices carry two kinds of high-dollar exposure. The first is drugs: a leuprolide or intravesical therapy claim can be several thousand dollars per administration, and a single wrong unit count, NDC, or missing authorization zeroes it out. The second is procedures with tight medical-necessity policies, such as lithotripsy, prostate biopsy, and newer BPH treatments, where payers deny when the conservative-therapy history is not on the claim. Add cystoscopy and urodynamics bundling edits that payers apply inconsistently, and a urology aging report fills with claims that are correct to appeal but sit unworked.
Common urology denials and the recovery path for each
| Denial | Typical cause | Recovery path |
|---|---|---|
| Buy-and-bill drug administration | J-code units, NDC, or dosage mismatch; drug authorized but administration denied; drug paid at zero as "included" | Corrected claim with NDC and units; appeal with the authorization and invoice; underpayment dispute on the drug allowable |
| Prior authorization for procedures | Lithotripsy, prostate biopsy, or BPH procedure performed without an authorization matching the CPT | Retro-authorization where allowed; appeal with imaging and conservative-therapy history |
| Medical necessity | Payer policy requires documented failure of medication before a BPH procedure, or specific PSA and imaging criteria | Appeal citing the payer policy with the clinical timeline |
| Cystoscopy and urodynamics bundling | NCCI or payer edits bundle a component procedure that was separately reportable | Corrected claim with the appropriate modifier; appeal citing NCCI policy |
| Pathology and lab | Biopsy core counts or units denied; urine cytology denied for frequency | Corrected claim with specimen count; appeal with medical-necessity documentation |
| Global period | Post-procedure visits or catheter changes billed inside the global without a modifier | Corrected claim with modifier 24, 58, 78, or 79 as appropriate |
What we look for in your aging report
- Drug claims (J-codes) over $1,000 denied or paid at zero
- Administration codes denied where the drug paid
- Lithotripsy and biopsy claims with an authorization denial and imaging on file
- Cystoscopy claims with a bundled component
- Visits denied inside a global period
Who it is for
Urology groups with 3–25 physicians, including practices with in-office infusion or injection suites, lithotripsy partnerships, and pathology labs.
Fee: 12–18% of recovered revenue by claim age, invoiced after the payer pays the practice. No setup fee, no minimum, no long-term contract. Start with the MARR 90+ Day Recovery Audit.
How it works
Send aging report
Your 90+ day aging report through a secure link under a BAA.
MARR analyzes recoverability
Every claim is checked against deadlines, payer rules, and the denial reason.
We work approved claims
Corrections, documentation, appeals, and disputes, claim by claim.
You pay on recovered revenue
Payers remit to you. Our fee is invoiced on remittances actually received.
Related articles
Sources
- CMS, Medicare Physician Fee Schedule (global surgery periods, multiple-procedure rules, modifiers)
- CMS, National Correct Coding Initiative (NCCI) edits and policy manual
- CMS, Medicare timely filing requirements
- CMS, Original Medicare appeals process and deadlines
- American Medical Association, prior authorization physician survey and resources
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.