Updates for the Hospital Outpatient Department (OPD) Prior Authorization (PA) Program

This webinar will review the prior authorization (PA) program for hospital outpatient department (OPD) services. Under prior authorization, the provider submits the prior authorization request (PAR) and supportive medical documentation to the Medicare Administrative Contractor (MAC) and receives an affirmed or non-affirmed decision prior to rendering the service. As a condition of payment, a PAR is required for the following hospital OPD services: blepharoplasty, blepharoptosis repair, and brow ptosis repairs; botulinum toxin injections; panniculectomy, excision of excess skin and subcutaneous tissue (including lipectomy), and related services; rhinoplasty and related services; vein ablation and related services; cervical fusion with disc removal, implanted spinal neurostimulators, and facet joint interventions. This webinar will review the PAR process review decision timeframes, common avoidable reasons for non-affirmations and documentation guidelines highlighting botulinum toxin injections; panniculectomy, excision of excess skin and subcutaneous tissue (including lipectomy), and related services; and rhinoplasty and related services. Members of our PA team will be available for questions relating to the PA program.