Take stock of CMS’ prior authorization demands

Medicare’s rules for prior authorization requests (PAR) for certain procedures performed in the hospital outpatient department (HOPD) are designed to prevent abusive utilization and billing. The Dec. 8 issue of Part B News reveals a skyrocketing rate of prior authorization requests.

 

When it started the program, CMS required prior authorization for five services that were performed on or after July 1, 2021: Blepharoplasty, botulinum toxin injection, rhinoplasty, panniculectomy, and vein ablation. Those services can be performed for medically necessary or cosmetic reasons.

 

CMS added cervical fusion with disc removal and spinal neurostimulator implants for services performed on or after July 1, 2022. Facet joint blocks and radiofrequency ablations joined the list for services performed on or after July 1, 2023.

 

Submitting a PAR is the hospital’s responsibility under the rule – although the practice can take over. And there’s a good reason for practices to submit the PAR or make certain that the However, CMS won’t pay any related Part B claims your practice bills, including the procedure and anesthesia services if the PAR isn’t submitted or is denied.

 

---