OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
07/31/2023
36 Months From Approved
151,451
0
0
73,242
0
0
0
0
0
The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for establishing a new prior authorization process and requirements for certain outpatient department (OPD) services. This process will be under the authority of §1833(t)(2)(F) which authorizes the Secretary to develop a method for controlling unnecessary increases in the volume of covered OPD services. It will establish criteria for identifying a list of outpatient department services requiring prior authorization and will focus on five groups of OPD services â Blepharoplasty, Botulinum Toxin Injections, Panniculectomy, Rhinoplasty, Vein Ablation, and their related services. CMS recently completed an analysis of the volume of covered OPD services furnished and recognized significant increases in the utilization volume of these services. CMS believes a prior authorization process for OPD services would ensure beneficiaries receive medically necessary care while protecting the Medicare Trust Funds from improper payments and unnecessary utilization
The annualized burden hours have decreased from 108,044 stated in the proposed rule to 73,242 hours in the final rule. The annualized burden cost has decreased from $3,851,504 stated in the proposed rule to $2,604,167 in the final rule. In the proposed rule, the hour/cost burden was calculated using historical claims data, which included all claims lines billed on the claim and inaccurately inflated the burden. For the final rule, CMS used historical data to calculate at the revenue line level, which allowed for a more specific estimate as it ensures that only the claim lines that included the selected codes are included in the estimate. Additionally, based on the comments received on our proposal, CMS included two additional HCPCS codes to the list of codes that require prior authorization. Coupled with the change in methodology in our claim line calculations, these changes resulted in a net decrease in burden hours and costs.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
CMS-10711 Prior Authorization Supporting Statement v2 (4-22-20).docx
Proposed Prior Authorization Proces