Feature
Cleaning up claims
Reviewing reimbursement denials with Ezana M. Azene, MD, PhD
All interventional radiologists are familiar with the difficulties that can accompany reimbursement claims.
Understanding the nuances of insurance requirements and denial explanations takes up valuable time. Ezana M. Azene, MD, PhD, a vascular and interventional radiologist with Gundersen Health System, recently began working to review medical reimbursement claims, intervening and overturning denials for standard IR procedures. Below, Dr. Azene shared
26 IRQ | FALL 2020
with IRQ some ways that IRs can avoid denial frustrations.
How did you get involved in reviewing medical cases? It kind of came out of frustration, because I had a number of bad experiences with prior authorization failures or situations where. even after the procedure, a patient was denied reimbursement. Many times there was a lack of knowledge in the person I was talking to when I was doing peer-to-peer follow-up, and they often did not have any knowledge of the procedures or even the disease
process that we were taking care of. I never once had an IR talking to me on the other side.
Finally I said, “If I’m complaining about this, maybe I should do something about it.” I looked into it and saw it was easy to become a medical file reviewer. I applied with a company—Medical Review Institute of America—and started doing file reviews.
What kind of medical cases do you review? I do mostly IR, and the most common cases that I see are treatment of pelvic congestion syndrome, uterine fibroid embolization and radio embolization. Occasionally I have a diagnostic radiology case to review, but I try to avoid doing those unless they’re really having trouble finding someone to do something like a breast MRI, for example.
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