May 13, 2022
by Admin

Rumored to be in existence, thought not to be…rare as the Tasmanian Tiger…the mythical Medicare Authorization does indeed exist. Worse yet, you need to know how to handle it, even though it technically is not a requirement for professional service providers (AKA Docs).

So…what are we talking about here? As of 2020 Medicare started requiring authorizations for specific Outpatient Department (OPD) services. This means services rendered at a hospital, at a surgery center (ASC) may fall under the criteria here.

Who does this impact? Anyone doing blephs, rhinos, pannics, therapeutic Botox, or vein ablation IN AN OPD.

Who is responsible for getting an auth? This is the tricky part…the hospital or ASC…NOT YOU.

Why do I care then? Because how is a surgery center or a hospital supposed to justify medical necessity for your patient and your procedure without you? They don’t have the documentation, the experience, the knowledge…maybe not even the staff…maybe not the aptitude or desire either.

So who is ultimately responsible? That’s right folks. You are. They aren’t going to do it for you more than likely and if there’s no approval…guess who gets a bill…your patient. Guess who your patient is mad at…that’s right again folks. The shi*t rolls uphill to their favorite plastic surgeon/dermatologist/NP/PA even if the bill is from someone else because you hold that patient relationship.

So what do I do? If you render services that are eligible for a fabled Medicare Auth…know your facilities and know the teams there. Have a plan. If they won’t do the auths with/for you…maybe you have a killer biller who does auths and billing…or maybe you have Auctus?

References in perfect MLA citation format:

The CPTs that matter.

The Medicare 101/FAQ Page.

The Big Ugly Operational Guide in all its glory.

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