The Centers for Medicare & Medicaid Services (CMS) have established a new prior authorization program for certain "cosmetic-like" hospital outpatient department (OPD) services that will take effect July 1, 2020. After a data analysis, CMS has found compelling evidence to suggest that some of the OPD procedures billed to Medicare may not be medically necessary. The result: increased scrutiny of medical necessity for some common and costly procedures, thus creating new revenue and compliance risks for hospitals.
During this RACmonitor webcast, Dr. Ronald Hirsch will provide you with the essential elements your hospital needs to achieve compliance with the new prior authorization program and improve medical necessity documentation for these procedures, thereby protecting reimbursement. He will review the data that led to the development of the program and the associated procedures. Dr. Hirsch will detail the medical necessity requirements for each procedure and will provide documentation templates. He will explain the data submission requirements and outline a best practice model to ensure that the requirements are met.
Register now and learn how to mitigate compliance risk and protect reimbursement under the new CMS prior authorization program effective July 1, 2020.
Why This is Relevant:
Certain outpatient department procedures such as vein ablations and blepharoplasty, when performed under the new CMS authorization program, will be targeted for medical necessity thus putting revenue and compliance at risk. These procedures are common and costly. And no facility can afford to give away these surgeries without the right to appeal payment denials. Few facilities have the capacity to design their program so having the elements provided to them will advance their ability to remain compliant.
- Understand the need to prepare for a new prior authorization program
- Learn which surgeries will be affected by the new program
- Learn how to delineate the medical necessity for each surgery
- Understand the data submission process for authorization
- Learn how to implement documentation templates for each surgery
Who Should Attend:
Those who will benefit most from this webcast include those in utilization review, revenue cycle, revenue integrity, case management and compliance, as well as chief financial officers, physicians and physician advisors, and billing and coding professionals.