Wiki Peer-to-peer review admin costs

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agibb1022

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My GI doc ordered a diagnostic imaging study for a patient and when we attempted to get prior authorization, they pended it and asked for copies of labs, previous studies, office visit notes, etc to be sent. None of those things were completed in/by our office as he is a new referral. We spent time gathering as much additional information as possible. They then denied the approval but said that the physician could complete a peer-to-peer review. My doc spoke with a physician from the insurance company for approximately 20 minutes regarding the information that we had sent to them and why the study was medically necessary. They ended up approving the study.

Can we bill the patient (or the insurance company) for a peer-to-peer review?

Thanks.
 
You cannot bill the patient. When I worked at the Medicaid PRO, Medicaid paid the peer review physician but not the physician who requested the review.
 
Thank you for your response, Debra.

I was pretty sure there was no way to get reimbursed for this, but my dr was adamant that we bill someone. Just wanted another opinion.
 
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