ASPS Comments on Medicare Waste, Fraud and Abuse Language

House Ways & Means Subcommittee on Health Chairman Kevin Brady (R-TX-8) released draft legislative language aimed at reducing waste, fraud and abuse in Medicare.

The draft is an omnibus bill with a variety of different strategies and programs that if implemented, would work to ensure the integrity of the Medicare program.

One section of the draft language would require prior authorizations for all blepharoplasty and eyebrow lift procedures. The section was drafted in response to an article by the Center for Public Integrity which investigated the tripling of Medicare claims for blepharoplasty procedures from 2001-2011.

ASPS commented that while Medicare does not require prior authorizations for other medical or surgical procedures, we are not opposed to their requirement, provided efforts are made to minimize the administrative burden it would place on practices.

ASPS stressed that the prior authorization requirements should be standardized across all Medicare Administrative Contractors (MAC), electronic forms should be implemented if possible and that MACs should have no more than 48 hours after the submission of all prior authorization requirements to notify the surgeon as to whether the procedure is approved or denied. Retrospective denials must be statutorily prohibited and a fair appeals process, based on appropriate evidence-based clinical guidelines with review by a board certified surgeon were also emphasized in the ASPS comments.

ASPS will continue to monitor the language as Congress returns to Washington, DC from their August recess on September 8.