Transcript

Know the number before the denial. · Medsolve Dynamics

Yoel Bakas: On November 5th, eviCore's new radiation oncology guideline takes effect. It lists osteoarthritis and plantar fasciitis as not medically necessary. Tennis elbow, early Dupuytren's, and keloids are still listed as medically necessary. The December 1st update keeps it that way. A radiation oncologist told me this month that most of his arthritis patients are in Medicare. So this barely touches him. And for a lot of programs, he's absolutely right. This guideline applies to the plans that use eviCore. It doesn't change Medicare's own coverage rules. But eviCore reviews affect more than just commercial plans. More than half of the people on Medicare are now in Medicare Advantage plans. And some of those plans send their radiation reviews to eviCore. At intake, Those patients look like Medicare. Benign runs on machines a program already owns with no new capital behind it. That's why the volume is worth protecting. So before the fifth, pull your benign courses from the last 90 days, sort them by payor and mark every one that goes to eviCore advantage plans included. That list is your exposure. And it's better to know it before the first denial tells you which ones apply.