Blepharoplasty Medicare Coverage

The surgery ranks third in all aesthetic operations performed in the United States. Sometimes it is done for cosmetic reasons while other times it is done to correct the field of vision. Insurance companies often deny most of the claims made out of this procedure (Kossler et al, 2015). There numerous challenges involved in performing the surgery, chief among them being the high rate of complications. However, there is a challenge when it comes to coverage by Medicare. Methodology This is both a quantitative and a qualitative study that seeks to elucidate whether more information to ophthalmologists can result in reduced claims denied by Medicare. Treatment on research variables will be done by providing more information too about 50 ophthalmologists from Bascom Palmer.

This will continue for about six months. At the end of the period. The researcher will check whether there was a reduction in the number of claims denied by Medicare. Participants will give written consent by signing a consent form indicating that they know the purpose and implication of the research and would wish to be participants of the study. Moreover, the researchers will assure the participants that information about them will remain confidential and cannot be divulged to third parties without their consent. Furthermore, they will not be required to give their names to protect their identity. Review of Literature Blepharoplasty is a cosmetic procedure that involves the removal of fat from eyelids (Kossler, 2018). Incisions are made during upper blepharoplasty to enable the healthcare provider to remove excess skin and fat.

Self-absorbing stitches have also been used, eliminating the need to remove them afterward. Healing can take about a week to ten days. Bruising and swelling is well resolved after about two weeks. Potential risks associated with the procedure include infection or bleeding (WebMD, 2017). Scarring could also result. A study conducted by Hardy et al sought to establish whether surgery duration was a good indicator of morbidity and clinically defining relevant time for increased risk (Hardy et al, 2014). The study found that increased operative time above three hours results in higher rates of complications. This study showed that besides procedural complexity, operative time was also an independent contributor to complications following blepharoplasty. Medicare Administrative Contractors (MACs) and Centre for Medical and Medicaid Services (CMS), at times, come up with policies that limit the number of items that Medicare can cover (Levinson, 2014).

MACs develop specific issues that cannot be covered by Medicare within its jurisdiction (Levinson, 2014). This is in contrast to inpatients who only pay the hospital deductibles of about $1,260 (Lind et al, 2015). Observational status is the classification of patients as outpatients even though they spend more days in the hospital bed (Lind et al, 2015) During this time, they may receive nursing care, and have diagnostic tests done on them. They may also use hospital supplies, medication, and food. Classification of a patient as an outpatient may be problematic to a patient (Center for Medicare Advocacy, 2018). This is because the patient does not meet the Medicare coverage requirement in a subsequent Skilled Nurse Facility if they do not spend at least three days in an inpatient setting (Bunis, 2018).

, p.  xx). Therefore, procedures involving blepharoplasty and billed to Medicare must be supported by patient complaints that justify functional surgery (CMS, n. d. , p. However, a significant number of patients are prevented from getting this care in the form of Blepharoplasty since Medicare has placed restrictions on how this can be covered. Moreover, the observation status rule locks out most patients from being covered by the insurer. This has seen a majority of patients pay for their care in SNFs out of their own pockets. This imposes a substantial financial burden on the patient. Other patients who cannot afford their care prefer to forego care altogether. Observation Status: New Final Rules from CMS Do Not Help Medicare Beneficiaries || Center for Medicare Advocacy.