Lindsay Conway, Oncology Roundtable
Although more and more cancer programs are offering low dose lung CT screening for high-risk patients, billing remains a challenge. Most payers still do not reimburse for the screening, and even when they do, there are often gray areas.
Below is a list of some of the questions I’ve received from members over the past year about billing for lung cancer screening. How are you managing these challenges? Please add your comments below, or email me at email@example.com.
Lung cancer screening billing and reimbursement challenges
Those of you who attended our 2009-2010 National Meeting series know that we profiled the work of the Patient Advocacy Foundation (PAF) for their efforts assisting uninsured and underinsured patients. PAF has just recently launched a new tool that "is intended to help underinsured individuals and families locate valuable resources and seek alternative coverage options or methods for better reimbursement." The tool, which is called the National Underinsured Resource Directory, is available free of charge from PAF's web site.
Users can search for assistance programs with key words (e.g. cancer) or by completing a questionnaire with information about the patient. The questionnaire prompts users to input basic information including demographics, insurance status, diagnosis and financial needs. As each question is answered, the tool displays the number of assistance programs for which the patient is eligible. Once the questionnaire is complete, the tool generates a report listing all matching assistance programs and their contact information.
In our 2009 National Meeting research on preauthorizations, we talked about the potential for cancer programs to obtain preauthorizations on behalf of referring physicians. At the time, we cautioned people that, while several cancer programs have engaged in this practice, it was a legal gray area and that any organization considering this strategy should seek legal counsel.
This week the OIG has released an advisory opinion indicating that, while securing preauthorizations or precertifications on behalf of referring physicians at no cost may violate federal anti-kickback statutes, the OIG would not impose administrative sanctions on providers that do so.