The question most often asked by providers during peer-to-peer (P2P) telephone conversations continues to be “How can I avoid doing so many peer-to-peer phone calls?”
The most obvious (yet also the most accurate) answer to the question of minimizing P2P calls is, “By providing the clinical information to clearly support approval on the very first submission.” While it is true that any imaging study not initially approved can be appealed, the process runs much more smoothly if eviCore receives the most relevant clinical information at the beginning of a case. The tasks associated with all appeals are time consuming, even the simplest fax to request additional clinical information. By providing supporting clinical information to eviCore, during the initial phone call or Web portal interaction, should enable rapid approval.
For example, if guidelines for an MRI for chronic knee pain (to rule out a meniscus tear) call for a recent plain x-ray and six weeks of conservative therapy, it is much more expedient to make sure the patient has had the x-ray and conservative treatment before requesting the scan. If your “prior-authorization employee” gives us the dates of treatment, a description of that treatment, and the result and date of the x-ray, the entire process need only take a few minutes, and no lengthy P2P call is needed.
eviCore understands that clinicians have a huge demand on their professional time, and we want to lessen the burden for everyone involved. In the coming months, this blog will be dedicated to giving you advice and tools that you can use to reduce denials, appeals, and P2P calls. We also ask providers and office staff to email us suggestions and questions that may help us make the entire prior-authorization process run more smoothly for everyone.
Take Home Point #2: To avoid denials and P2Ps, be proactive; anticipate and prepare the clinical information that eviCore will likely need, and provide that information to your prior-authorization employee to get approval during the initial request.
Author: Robert L. Neaderthal, M.D.
Robert L. Neaderthal, M.D. has been a medical director at eviCore healthcare for seven years. Prior to joining eviCore, he served for 30 years as a primary-care internist in Nashville, Tennessee. Since joining eviCore, Dr. Neaderthal has been committed to helping other providers avoid peer-to-peers by educating them on ways to avoid denials.
For more tips on how to avoid peer to peer phone calls, read Tip 1 of the “How Can I Avoid Peer to Peer Phone Calls” series here.