Billing/Reimbursement Issues and Concerns

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Medical billing is an increasingly hot topic as insurance companies have become more involved in dictating reimbursement, which in turn dictates patient treatment and the modalities available to our patients.  While insurance companies may be swayed via a peer to peer process, this is time consuming and must be done on a patient specific basis.  I invite the members of our group to comment here on the troubles they've faced and what solutions, if any, they have found to be helpful.

In our institution, we have recently received automatic denial for medium and high risk prostate patients (Gleason 3+4 and above) for HDR mimicking SBRT protocols.  This is perhaps in response to a statement published by ASTRO regarding appropriate treatment pathways for prostate patients.  This is a cohort of patients that we have a long history of treating successfully that are no longer candidates.  It is yet to be seen what success we have negotiating with insurance companies or if peer to peer is even warranted.

I would appreciate your thoughts.

Kiernan