PeerPoints for Payers

Clinical Updates for Claims and Medical Management Professionals

Off-Label Use of Biological Agents in Rheumatological Diseases

 

First-Trimester Aneuploidy Screening

 

Identifying and Reducing Overutilization of Epidural Steroid Injections

Criteria-based decision making regarding the use of epidural steroid injections (ESIs) plays a critical role in not only determining the proper authorization and coverage of these services, but also in ensuring that qualified patients receive the appropriate number of treatments. Millions of dollars are spent each year on initial injections that are medically unnecessary, and on the administration of repeat injections despite the failure of a first series of ESIs to provide significant, persistent pain relief. Improper reimbursement of ESIs results not only from improper medical utilization, but also from the inadequate documentation of either the diagnostic findings or the measures associated with pain relief.

Battling Childhood Obesity with Bariatric Surgery

With childhood obesity becoming an ever-present epidemic, the issue of patient qualification for bariatric surgery needs to be revisited. Recent data shows that nearly 17 percent of US youth between the ages of six and 19 are considered overweight.

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