OVERLAND PARK, Kan. (Jul 9, 2020) — Beginning July 1, 2020, Medicare will require prior authorization for five types of surgery – blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation – performed at hospital outpatient departments (OPDs). According to the Centers for Medicare and Medicaid Services (CMS), the prior-authorization process serves as a method for controlling unnecessary increases in the volume of these services, and these changes mean that both providers and patients will know earlier in the process if Medicare will likely cover the hospital OPD service. For over two decades, providers across the country have turned to eSolutions to streamline the manual process of submitting documentation to CMS and their Medicare Administrative Contractor (MAC). And now, using the Medicare esMD tool available from eSolutions, providers are better able to route prior-authorization documentation submitted via esMD (electronic submission of medical documentation).
It has been a primary goal for eSolutions, the industry’s leading Medicare billing experts, to reduce providers’ manual process of submitting documentation to Medicare – and with Medicare esMD, providers can use a single, web-based tool to securely transfer and track documents.
Before now, Medicare has never paid for what it considers plastic surgery, including hooded eyes/eye lift procedures. Now, however, Medicare will pay when any of the five procedures is pre-authorized. Hospitals are responsible for obtaining prior authorization before the procedure, even though surgeons determine medical necessity and scheduling, and perform the procedure. According to CMS, prior authorization for these services ensures that beneficiaries continue to receive medically necessary care, while also keeping the medical necessity documentation requirements unchanged for providers.
Prior-authorization requests and documentation are submitted to the provider’s MAC. If the MAC determines medical necessity, it will issue a Unique Tracking Number (UTN) for hospitals to put on the claim before submitting it. UTNs are now required. Without a UTN on the claim, it will be denied. For claims that include a UTN, MACs will complete their review and issue a decision within 10 business days.
Prior authorizations are required for services performed on or after July 1, 2020. MACs began accepting prior-authorization requests starting June 17 for requests submitted via fax, mail and the MAC electronic portals. Submissions through esMDs began July 6.
The new 8.5 code allows hospitals to request a UTN and begin the process for patients without having to wait for snail mail or expend precious staff time getting approval over the phone. eSolutions’ products now support all 14 content codes in esMDs, including 8.5.
Learn more by visiting this page or call 866-633-4726.
eSolutions’ powerful, easy-to-use revenue cycle and workflow management tools, paired with actionable data insights, strengthen our clients’ revenue health by shortening the time between claims submission and payment, reducing audit and compliance risk, improving overall operational outcomes and ensuring healthcare providers are paid accurately for the care they deliver through our revenue integrity solutions. For more than 20 years, providers of all types, including the nation’s largest post-acute care organizations and health systems, have trusted us to deliver innovative solutions and second-to-none client service. We find deep satisfaction and purpose in finding solutions to tough challenges and caring for our clients just as they do their patients.