eSolutions’ Tool Helps Providers Manage New CMS Prior-Authorization Requirements for Outpatient Procedures Print
Thursday, 09 July 2020 06:00


OVERLAND PARK, Kan., July 09, 2020 (GLOBE NEWSWIRE) -- Beginning July 1, 2020, Medicare began requiring prior authorization for five types of surgery – blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation – performed at hospital outpatient departments (HOPDs). 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. For more than 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). Now, using the Medicare esMD (electronic submission of medical documentation) tool available from eSolutions, providers can implement a new content code – 8.5 – that further helps route prior-authorization documentation submitted via esMD.

It has been a primary goal for eSolutions, the industry’s leading Medicare billing experts, to reduce the manual process for providers when they submit documentation to CMS. eSolutions’ Medicare esMD is a single, web-based tool to securely transfer and track documents – streamlining the overall electronic submission of documentation and medical records.

Before now, Medicare has never reimbursed providers for what it considers plastic surgery, including hooded eyes/eye lift procedures, but it will now pay when any of the five procedures is pre-authorized. Hospitals are responsible for obtaining prior authorization before the procedure, while surgeons determine medical necessity and scheduling in order to 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.

Providers submit prior-authorization requests and documentation to their MAC. If the MAC determines medical necessity, it will issue a Unique Tracking Number (UTN) for hospitals to include on the claim before submission. UTNs are now required, and Medicare will deny the claim if it is not included. 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 prior authorization process without enduring manual authorization processes through the phone or traditional mail, both which cost precious time and resources. eSolutions’ products now support all 14 content codes in esMDs, including 8.5.

Learn more about eSolutions’ Medicare esMD tool here, or by calling 866.633.4726. 

About eSolutions

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, and improving overall operational outcomes. 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.

Holly Rohleder
Marketing Director
(913) 971-4381
[email protected]

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