Radiation Oncologists Meet with BCBSNC to Discuss Pending Medical Policy Changes for IMRT

In late December, BCBSNC announced that it had revised its medical policies for Intensity Modulated Radiation Therapy (IMRT), and that the new policies would take effect April 1, 2010.  The changes prompted concerns from members of the radiation oncology community.  In response, NCMS coordinated and hosted a meeting between representatives of BCBSNC and six radiation oncologists from around the state and two representatives of the NC Medical Group Managers Association.  Led by Kevin Roof, MD, of Charlotte, the group also included the chairs of the Departments of Radiation Oncology from Duke, UNC, and Wake Forest Medical Schools.  During the meeting, which took place on Wednesday, March 3rd, Genie Komives, MD, VP, senior medical director, healthcare quality, for BCBSNC, explained the rationale for the policy changes and the process for obtaining expedited appeals when the procedure is denied as investigational.  The group provided significant information about the efficacy of IMRT for cancers that the policies indicate are investigational and therefore not covered (as of 4/1/10, IMRT will be covered only for prostate and head and neck cancers, although IMRT denials for other cancers can be appealed on an expedited basis if necessary).   At the request of Dr. Komives, one month after the policy has been in effect, the group will reconvene to review the cases that were initially denied and subsequently overturned to see if a change in the policies are warranted.

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