In The News

Effective April 1, 2014, UnitedHealthcare will implement a new online prior authorization program for key radiation oncology services for patients with specific Medicare Advantage Plans.

UnitedHealthcare states this program will provide a review of treatment compliance with the Centers for Medicare and Medicaid Services (CMS) National Coverage Decisions (NCD), Local Coverage Decisions (LCD) and UnitedHealthcare medical policies for intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). In the FAQ on the UnitedHealthcare Website, United says authorization is required prior to the start of therapy, as well as each time a member starts a new IMRT, SRS or SBRT treatment regimen.  The Radiology Benefit Management (RBM) firm, CareCore will conduct the reviews.

In response, the American Society for Radiation Oncology (ASTRO) posted in its Website its concerns over the use of radiation oncology benefit managers that interfere with the process of care and undermine the ability of radiation oncologists to individualize patient treatment. ASTRO says it plans to meet with CareCore officials to learn more about the program and to raise concerns.

More information about this program is available on United Healthcare’s website that includes a training seminar schedule, frequently asked questions, a link to related clinical coverage policies, and information on getting started.
https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=578bd10835ca4410VgnVCM2000002a4ab10a

Additional Information can be found on ASTRO’s Website at:
https://www.astro.org/Practice-Management/Reimbursement/Private-Insurance/Managed-Care.aspx