Key takeaways from this episode

• New technology has two reimbursement hurdles, coding and coverage, and coverage is the harder one. A reportable CPT or HCPCS code does not mean a payer will pay; commercial payers wait for demand, peer-reviewed literature and Medicare's position, then run actuarial projections before adopting a service.
• Verify the true reimbursement and a full ROI before introducing any new device or service, especially the expensive ones. Vendors' reimbursement stories are often optimistic, so build a full business plan, workflow and documentation standard before the first case.
• Do not let a physician launch a technology the week after a meeting without the team's involvement. Adoption takes more than one practice and more than one person; clinical and financial staff both need to understand the plan.
• Vet administrative AI tools as carefully as clinical ones. Practices are being pitched AI for every part of the revenue cycle; PRS is pre-vetting vendors such as SurgExplain and Docology at the AUA and will report back through the hub and UPTP.
• Staff the billing office adequately to work EOBs and file appeals. Ray's warning: practices that skimp on billing staff lose more in unworked denials, record requests and takebacks than they save in salary.
• Give billing and operations staff the time and information to handle prior authorizations, record requests and denials. The operational service delivered to patients depends on the support team, and top-to-bottom communication is now critical to getting paid.
• Join the UPTP (Urology Pharma and Tech Pioneer) group at prsnetwork.com/joinuptp to compare notes on new technology adoption. PRS also updates the hub at prsnetwork.com/urologyhub with new product pages, CodeMatrix guides and calculators; early bird seminar pricing ended May 15.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 288, recorded May 2026, with Scott Painter, Mark Painter and Dr. Ray Painter of PRS Network.

Why PRS is partnering with the AUA Innovation Nexus

[00:00] Scott Painter: On this episode: new technology. What do you do when you come across it? Stay tuned. Welcome to episode 288 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter and Dr. Ray Painter. Today we want to talk about new technology and reimbursement. As we've said before, when we work with new technology or new services, our goal is to be the entity that helps smooth out the reimbursement hurdles, because we believe urologists and urology practices should all have the latest technology available to choose from to treat patients, and patients should have access to that technology if it's available and will help their condition.

One of the things happening next week is the Innovation Nexus program from the AUA. Mark and I are traveling to Washington, D.C., and we're participating in the Innovation Nexus section as the coding and reimbursement information partner of the AUA. We want to talk with a lot of the companies that have exciting new technology coming down the pipeline and get them headed in the right direction, so the reimbursement hurdles are reduced and we can help all of your practices adopt these new technologies more quickly and in a more streamlined way. Mark, do you want to share a little about what we're going to be talking about, and maybe a few companies you've already talked to?

[02:23] Mark Painter: Sure. We're definitely excited to partner with the AUA on the Innovation Nexus program. It's a project started by the AUA to take a look at technology and get involved with it early. Part of it, of course, is the clinical piece: looking at what's out there that shows clinical progress. The Innovation Nexus group has grown over the last couple of years as it has looked at problems tackled by residents and explored the pathway from idea to product launch. They've now expanded it to bring together finance groups as well as support groups like PRS that are needed to help these companies navigate the complicated U.S. system. Our little niche in that process is the coding and reimbursement side.

We've worked with a number of companies over the years, some of whom never made it to market, and talked with them about when to approach the AUA or the AMA about a code, how to look at strategies, how to explain it to investors, and what the projections are. Some failed FDA trials and didn't go forward. Some ran out of money. A lot of this goes forward only to a certain point, and what finally gets fully introduced to the market represents a fairly long pathway, usually starting with testing in other countries, then building the marketing programs and figuring all of that out. A lot of these groups are so focused on the clinical that they don't spend the time to figure out the real-world portion of reimbursement.

The reason we wanted to introduce you to this is, number one, the exciting new technology that's out there. But the second piece is that we know from years in the marketplace that many physicians go to these larger meetings, maybe this is the one meeting they go to this year, and they come back all jazzed about a new technology and its clinical value to their patients, and they want to start it right away. They've been told stories about the reimbursement side, that it's a big breadwinner and needs to be implemented tomorrow. So we're trying to meet with these folks, find all these new technologies, and build out the urology hub, talking to them about what the reimbursement picture really is so we can do some analysis and give you what we see in the marketplace.

When we get to the end game of all of this, there are a couple of things to consider, as you've always heard. One is coding, which is important: how do you report it? The second, and equally important, is coverage: whether a payer is truly going to adopt this new technology as something they will pay for, and under what circumstances. That takes time, and as we've discussed in the past, it takes market demand, because the payers in the current U.S. system are not forward thinking. They are demand responsive. As new technology comes down the pipeline and shows great promise, the payers are not going to take the lead and say, "Awesome, here's a new technology, here's what you get paid for it, go to town." Their process is much more, "Let's take a look at who's using it. Let's see where the demand is. Let's see where it fits. Then we'll look at the peer-reviewed literature, see what Medicare is doing with this technology, and then maybe we'll consider it, because we need to run the actuarial projections. We need to find out what, if anything, this is going to replace, how much it's going to cost, whether it's going to drive more patients into the system, and whether it's cost-effective for all these patients relative to the existing treatments." That's a battle we always have to consider.

Now flip that to the physician office, and you have many of the same things to consider. That's why we've always recommended, when looking at new technology, that you are very careful in developing a full-blown business plan, workflow and documentation to support what we know at the time we introduce it to the practice. We definitely need those pioneers, and we have our UPTP group that spends a lot of time talking about these new technologies and how things are going, and it takes more than one practice to drive all of this. So it's a partnership in the end, and one that requires everybody to understand both the clinical and the financial.

Check the true reimbursement before you implement

[09:17] Scott: So true. You mentioned our UPTP group, our Urology Pharma and Tech Pioneer group. As a matter of fact, we're meeting again next Tuesday. If you're hearing this and want to join, go to prsnetwork.com/joinuptp. Ray, comments, questions?

[09:45] Dr. Ray Painter: I think it's exciting that you're back working with the AUA directly and trying to provide the information people need to introduce new technology.

[10:01] Scott: In the past you've done a lot of work with new technology, had a lot of successes, and seen a lot of roadblocks in your day. What advice do you give urologists going to the AUA who are looking at all these new devices?

[10:21] Ray: If you get a chance, I think it would be fun to go to the Nexus part of the AUA. But if not, you need to listen to what Mark said. You need to be sure you check out the true reimbursement for that particular product before you introduce it. We've said for years that you need to have your ROI fully understood before you start implementing, and it's really true with the more expensive stuff coming out now.

AI, new treatments and the exhibit hall

[11:06] Scott: Very true.

[11:09] Mark: I was going to say the Nexus is exciting because it's the what's-next arena. Judging from the list of folks who are going to be there, we're going to see more and more of the merging of AI and clinical, and how that's going to be a topic of conversation. We know it's a topic of conversation with the AMA and the Digital Medical Coding Committee, and they're trying to get ahead of it, and we'll have to see how all of that functions in the market. There's also going to be technology introduced that offers new approaches to treatment of disease states, or improvements to treatments, and it will be exciting to see what's coming down the pipeline. And of course, not everybody goes to the Innovation Nexus portion. You've got the Science & Technology Exhibit Hall, which is a sprawling place with so many different vendors, all introducing new things or improving their delivery and the products they have. It's a lot to take in. Ultimately it is exciting to look at the new options for patient treatment and the growth in patient care we can provide with all these new advancements. And it's important, as we keep mentioning, to understand how that can practically fit into the practice: not just the dream, but the reality.

AI for the administrative side, and sponsors

[13:10] Scott: Taking the other side of AI, I see on the list of presenters a couple of groups we've been talking to and gotten to know, SurgExplain and Docology. Those are geared more toward the practice and the administrative side from an AI perspective, not the clinical side. We understand that all your urology practices are looking at this new AI, and I know you're getting pitched a ton of different AI solutions for various parts of your practice. That's another place we want to help by talking with a lot of these folks and getting to know what they're doing, what their teams look like, and how they're reaching out to practices to solve problems along that wheel of payment. There are all sorts of pieces to that reimbursement pie. So we're doing some pre-vetting, if you will, talking to those groups and letting you know what we find out and who we're talking with. We want to bring that back from the AUA as well. These new technologies are coming not only on the clinical side, but on the practice administration side too.

That's all we have for today's episode as far as discussion. I want to get some final thoughts, but first we want to thank ModMed for supporting this episode. If you're in the market for an EHR or practice management system, go to modmed.com/prsnetwork for specials for our listening audience. Mark also mentioned the PRS Coding and Reimbursement Hub. We're adding new products and categories all the time, and new CodeMatrix guides and calculators. Go to prsnetwork.com/urologyhub to check out the information we have there. We have a lot getting updated in the next couple of weeks around the AUA meeting, so please check back as we update the hub. And finally, registration for the Urology Advanced Coding and Reimbursement Seminar is open. Go to prsnetwork.com, and right there on the homepage is a Seminar Registration button you can click for more information. Keep an eye out: our special early bird pricing ends May 15, so if you want that pricing, we encourage you to get in. Okay, let's get some final thoughts. Mark, final thoughts?

Final thoughts: support your billing and operations team

[16:41] Mark: One of the key final thoughts I'll bring in today is that your administrative support team, your billing team, and the administrative side, purchasing, office flow and operations, are a very important part of the practice. Everyone knows that, but sometimes overlooks it. The patient is first, but the operational service you can give your patients is totally reliant on your support staff. All of these new technologies, and quite frankly even existing technologies, are not one size fits all, figured out and done. The whole reimbursement game is a very dynamic world right now. Let the folks who support you do their job. Give them the time and the forethought they need to do everything that goes into getting you paid for providing those services. In today's market that includes prior authorizations and everything done before the visit, as well as the straight payment work. And right now we're dealing with all these medical record requests, takebacks and denials. It's a complicated world and a big load on the folks supporting you in the background. The more you communicate with them, and the more the team functions from top to bottom in an integrated fashion, the better off your practice will be in this incredibly complex and moving environment. It's not a static world, and it's not an easy one. It doesn't just happen and then you get paid. It never has, but it's now absolutely critical in your planning to make sure everybody in the practice, top to bottom, is on the same page.

[19:04] Scott: That is so crucial. Ray, final thoughts?

[19:10] Ray: Two points. One: when I first started giving talks around the country, when the payment systems were just beginning to change for physicians and speed bumps were being thrown into getting paid, people used to ask me, "How could you possibly go around the country year after year talking about the same thing?" My answer was quite simple: it's easy. I don't even change the questions, because the payers keep changing the answers. And that was just a drop in the bucket compared to the changes occurring today. The second point: don't be penny wise and pound foolish. I can't tell you how many practices we've been into to evaluate their billing, coding and collections, only to find they didn't have enough staff to spend the time needed working the EOBs and making the appeals that needed to be made. You really need to have enough staff to do the job that has to be done, because the times, they are a-changing.

[20:39] Scott: Indeed. That's all we have for today. Thank you all for listening, and if you see us at the AUA meeting, say hello. Take us out, Ray.

Ray: Happy coding.

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