White Glove Medical Billing logo
Medical Billing

Surviving a Peer-to-Peer Review

A peer-to-peer is a scheduling and preparation problem more than a clinical one, and the practices that win them treat it as a defined workflow.

← Back to Blog
2 min read · by White Glove Medical Billing
Two chairs facing each other across a small table

A peer-to-peer review puts your provider on the phone with the payer's reviewing physician to argue for a service the plan has declined to authorize. Practices lose them for reasons that have little to do with the medicine.

Why they get lost

  • Scheduling. The window to request one is short, and the call has to happen inside it. Miss it and the denial stands regardless of merit.
  • The wrong provider. Whoever is available takes the call rather than the one who knows the patient.
  • No preparation. The provider joins without the chart, without the plan's criteria, and without knowing the stated reason for denial.
  • Arguing generally. Explaining why the service is good medicine, rather than why it satisfies the criteria the reviewer is applying.

The workflow that wins them

  1. Request immediately on denial — same day, tracked to a named owner.
  2. Book the treating provider specifically, with protected time.
  3. Brief them beforehand: the denial reason, the plan's own criteria, and where the record satisfies each one.
  4. Have the chart open and the relevant findings marked.
  5. Record the outcome and the reasoning, because the same argument will recur.

The framing that helps

The reviewer is applying criteria, not forming an independent clinical opinion. The persuasive move is to walk them through the criteria and show where each is met. That is a preparation task, and it is why the practices that treat peer-to-peer as a workflow rather than an interruption do measurably better at them.

Denials Piling Up?

We handle the revenue cycle end to end — coding by certified coders, claim submission, denial management and appeals, and A/R follow-up, with six reported numbers every month.

Get Started

The fastest way is to call. If you prefer, you can book online below.

(949) 554-8072
or

Book Online

Share your details and preferred availability.