How Marking a Medicare Oncology Case “Urgent” Impacts the Review Process.

Timelines for Medicare oncology cases are set by CMS rules. Standard cases are typically decided almost as quickly as urgent ones, so requesting urgent review gains little time, while the shorter urgent timeline leaves less room to provide any missing information.

Medicare Case Timeline

• An urgent request allows only 24 hours total to cover eligibility verification, clinical review, notification, and any peer-to-peer consultation.
• If information is missing, we’ll reach out to your office. But if it isn’t received in time to meet the mandatory CMS timeframe, a determination will need to be made based on the case as submitted.
• A standard case must be completed within 72 hours, but at EviCore, 99% of standard Medicare oncology cases are completed within 48 hours.

When “Urgent” Is Appropriate

Request “urgent” review only when the standard timeline could seriously jeopardize the patient’s life, health, or ability to regain maximum function.

What to Include with Every Request

• Notes: Your most recent medical oncology notes (and other provider notes if applicable), including history and physical, cancer type and stage, assessment and plan, prior and current treatments related to this condition, and rationale for the current request.
• Test results: Relevant, recent lab work and imaging along with pathology and molecular studies if applicable.
• Full regimen: All planned drug names (including both chemotherapy and supportive drugs) with J-codes, and when prompted, dosing details for the full regimen including doses per cycle, total number of cycles, and frequency.

Bottom line: Choosing the right status up front matters. Requesting urgent review rarely saves meaningful time, and standard cases are typically decided almost as fast.