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Prior Authorization Exemption: Part B Provider Role

CMS has identified certain Part A HOPDs as having a prior authorization affirmation rate of 90% or greater. As a result, these HOPDs are currently exempt from submitting prior authorization requests for all procedures within the Prior Authorization program. CMS will be re-assessing compliance rates for these hospitals later this year by requesting records in late September, 2021 and issuing decisions in December 2021.

Part B physicians who are planning on performing services in an exempt HOPD are also exempt from the prior authorization request process until the decision to withdraw or continue exemption is issued in December, 2021.

Part B providers are reminded to check the exemption status of each OPD at which they perform services that require prior authorization. When the OPD is exempt from prior authorization, the physician should not be submitting a prior authorization request on behalf of the exempt OPD. If, however, the OPD is not included on the list of exempted OPDs, a prior authorization request is still required.

Posted 6/3/2021