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CMS sets new rules for 5 hospital outpatient services — 5 things to know

New Medicare prior authorization requirements will take effect for certain hospital outpatient department services July 1, according to Bricker & Eckler's Shannon DeBra.

Five insights:

1. Blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation services provided in HOPDs will require prior authorization on or after July 1.

2. CMS will deny claims for these services in the hospital outpatient setting if prior authorization isn't obtained.

3. Any claims "associated with or related to a service … for which a claim denial is issued" will also be denied. These associated services include anesthesiology services, physician services and facility services.

4. Starting June 17, Medicare Administrative Contractors will accept prior authorization requests for dates of service beginning July 1. No specific form is needed to request prior authorization.

5. CMS' updates to prior authorization processes and requirements are intended to help control unnecessary volume increases. The updates were established in the 2020 Outpatient Prospective Payment System/ASC Final Rule.

More articles on surgery centers:
The 'new normal' for ASCs: 16 admins on how the pandemic will change the field forever
Dr. Thomas Vikoren: Same-day TJR 'made all the more important' by COVID-19
Indiana orthopedic practice with surgery center to open 

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