11/02/2015    Paul Kesselman, DPM

New Requirement for MRI Request? (Jeffrey Kass, DPM)

This does indeed seem absurd, especially if they
are paying you for taking and interpretation of
the original x-ray. You should check with your
provider representative.

Here's another slant on this: The radiologist who
takes the x-ray has minimal if any clinical
information on this patient and if based on your
studies will the carrier pay the radiologist for
reading your studies when they've already paid
you. How can the radiologist be the watchdog or
gatekeeper of what is necessary? That should
absolutely be left in the hands of the clinician
treating the patient's symptoms, regardless of
specialty and regardless of degree.

Of course the radiologist has only the barest of
information which the clinician provided if the
outside radiologist did indeed take the films.
Their reports will now all have to read "if
further clinical symptoms continue or worsen, or
if further clinical correlation is required an
MRI CT ETC. may be warranted.

So, I would now say to the ins carrier what
clinical symptoms and info does the radiologist
have? What financial disincentive is there for
the radiologist not to order further testing on
these patients? Perhaps the reviewer you spoke
with is new to this role.

I would demand an expedited peer-to-peer review.
If that fails, you definitely should contact your
provider rep and NYSPMA. Also get your patients
involved as they are the best advocate.

Paul Kesselman, DPM, Woodside, NY

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