The American Association of Orthopaedic Surgeons is backing new federal legislation that would restrict Medicare Advantage insurers from reversing coverage decisions after care has been provided.
The Protecting Approved Care Act would require Medicare Advantage organizations to honor original coverage decisions and establish safeguards against retroactive coverage denials and recoupment of payments already disbursed, according to a Sept. 15 news release.
The bipartisan bill was introduced by Reps. Greg Landsman, D-Ohio, and Bob Onder, R-Mo. AAOS said Medicare Advantage plans can retroactively deny coverage, reduce payments or recoup payments after procedures that received prior authorization or did not require it.
AAOS President Wilford Gibson, MD, said the practice can leave physicians and patients with unexpected financial burdens after care has been delivered.
The organization also cited American Medical Association data showing nine in 10 physicians reported that prior authorization somewhat or significantly increases burnout. AAOS said 36% of Medicare Advantage enrollees report annual incomes of less than $25,000, according to the release.
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