HCPro, JustCoding Outpatient - 2020 Issue 24 (June)
Healthcare News: CMS details prior authorization process for certain HOPD services
June 16th, 2020
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Article Overview
This article explains CMS guidance on prior authorization requirements for selected hospital outpatient department services under the 2020 OPPS final rule. It summarizes the effective date, request timing, standard and expedited review periods, and the types of MAC decisions that may be returned. The piece is relevant to hospital outpatient coding, billing, and compliance teams tracking Medicare outpatient policy updates and HCPCS-related prior authorization procedures.
Why This Topic Matters
These CMS requirements affect how certain outpatient services must be processed before claims are submitted, which can influence scheduling, documentation workflow, and reimbursement readiness for hospitals and billing staff.
What You Will Learn
- Which hospital outpatient department services are subject to upcoming prior authorization requirements
- When prior authorization requests may be submitted and when the requirements take effect
- How CMS describes the standard and expedited review timeframes
- What decision types a Medicare Administrative Contractor may issue in response to a request
- Where to look for additional CMS guidance on handling prior authorization outcomes
Who Should Read This
- Hospital outpatient department billing staff
- Coding professionals
- Revenue cycle teams
- Compliance staff
- Medicare billing specialists
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