We are all familiar with the notion of appealing insurance denials of medication coverage, claims, line item issues of claims, and precertifications for procedures such as biopsies and imaging. While following payer protocols may eventually resolve an immediate issue, the necessary investment of time to resolve these matters becomes frustrating and daunting. An examination of practice–payer relations shows that perhaps a more comprehensive evaluation of this system is needed.
As they navigate payer requirements, practices and care facilities find that they are able to reach their highest standard of documentation and billing compliance only by applying focused effort and dedicated resources.
Half or more of oncology care is paid by payers other than Medicare or Medicaid. Does your cancer center have a defined strategy for communications, contracting, and program development with these payers?
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