Prior Authorization
Demonstration for Certain Ambulatory Surgical Center (ASC) Services
(CMS-10884)
New
collection (Request for a new OMB Control Number)
No
Regular
08/22/2024
Requested
Previously Approved
36 Months From Approved
96,912
0
59,904
0
0
0
Section 402(a)(1)(J) of the Social
Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J)) authorizes
the Secretary to “develop or demonstrate improved methods for the
investigation and prosecution of fraud in the provision of care or
services under the health programs established by the Social
Security Act (the Act).” Pursuant to this authority, CMS seeks to
develop and implement a Medicare demonstration project, which CMS
believes will assist in developing improved procedures for the
identification, investigation, and prosecution of Medicare fraud
occurring in ambulatory surgical centers providing services to
Medicare beneficiaries. The information required for the prior
authorization request includes all documentation necessary to show
that the service meets applicable Medicare coverage, coding, and
payment rules. Prior to rendering the services, ASC providers
should submit this information to the Medicare Administrative
Contractors (MACs). Trained clinical reviewers at the MACs will
review the information required for this collection to determine if
the requested services are medically necessary and meet Medicare
requirements. If an ASC provider does not submit a prior
authorization request before rendering the service and submitting a
claim to Medicare for payment, the MAC will request the required
information from the ASC provider to determine if the service meets
applicable Medicare coverage, coding, and payment rules before the
claim is paid.
PL:
Pub.L. 90 - 248 402 Name of Law: Social Security Act
US Code:
42 USC 1395b-1(a)(1)(J) Name of Law: Incentives for economy
while maintaining or improving quality in provision of health
services
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.
ASC Prior Authorization Supporting StatementClean.docx
Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services