Post #36: Oncology Imaging - following oncology guidelines will ensure rapid approvals and will avoid peer-to-peer calls

Recommendations for diagnostic imaging in patients with cancer varies with specific cell types, the organ(s) involved and when in the course of diagnosis and treatment the imaging is needed. Although many national specialty organizations publish guidelines for the treatment of malignancies, most radiology benefits managers use those criteria published and maintained by the National Comprehensive Cancer Network.

Post #32: Venous Thromboembolism – diagnosis and follow up imaging

One of the most common chest abnormalities seen in medical practices is the unexpected and asymptomatic solitary pulmonary nodule. Often these nodules are discovered on a chest x-ray or incidentally on a non-chest CT scan. Regardless of how they are discovered, differentiating a benign nodule from an early malignancy is critical. Guidelines are available and are used by radiology benefits management companies to authorize an initial assessment as well as follow-up imaging. Using these guidelines will ensure imaging requests that will be approved quickly without denials and peer-to-peer calls.

Post #31: Pulmonary Nodules: Size really does matter

One of the most common chest abnormalities seen in medical practices is the unexpected and asymptomatic solitary pulmonary nodule. Often these nodules are discovered on a chest x-ray or incidentally on a non-chest CT scan. Regardless of how they are discovered, differentiating a benign nodule from an early malignancy is critical. Guidelines are available and are used by radiology benefits management companies to authorize an initial assessment as well as follow-up imaging. Using these guidelines will ensure imaging requests that will be approved quickly without denials and peer-to-peer calls.

Post #28: Knee pain and Injuries: When to wait. when to treat, and when to request an immediate MRI?

Primary care providers and orthopedists alike often fail to obtain approval for a knee MRI, leading to lengthy peer-to-peer calls to overturn the denial and approve an appropriate and medically indicated test for their patients. Most of these denials are avoidable. Attention to detail and communication of key clinical information can ensure immediate approval by physicians every time.

Post #27: Shoulder Pain and Injuries: When to wait, when to treat, and when to request an immediate MRI?

Primary care providers and orthopedists alike often fail to obtain approval for a shoulder MRI, leading to lengthy peer-to-peer calls to overturn the denial and approve an appropriate and medically indicated test for their patients. Most of these denials are avoidable. Attention to detail and communication of key clinical information can ensure immediate approval by physicians every time.

Post #25: Diagnostic testing for Coronary Artery Disease – Coronary CTA

Guidelines for CCTA are evolving and expanding each year.  To consistently obtain prior authorization, it is critical to consult the most up-to-date guidelines. Providers should download the latest guideline to your desktop every year and to communicate clearly the patient’s clinical features to the radiology benefits manager (RBM). At the end of this post I will tell you how you can stay up-to-date with RBM guidelines.

Post #20:  How to Avoid Peer-to-Peer calls by selecting the correct contrasted CT scan: Dual contrast studies (without and with contrast) and triple contrast studies - Part II

Prior authorization companies often deny requests for abdominal imaging even though the provider asked for the right test but with the incorrect contrast component.   Learn when to request Dual Studies (CT abdomen without and with contrast) or Triple studies (CT without, with, plus additional views).

Post #19:  How to Avoid Peer-to-Peer calls by selecting the correct contrasted CT scan: CT without contrast, with contrast, or a dual study (without and with contrast) - Part I

Radiology Benefits Managers often deny requests for abdominal imaging even though the provider asked for the right test but with the incorrect contrast component.   Learn when to request CT abdomen with contrast, when to request CT without contrast and when both should be requested.