Be ready to defend your Medicare billing of blepharoplasty, or “eyelid lifts.”
A report by the
Center for Public Integrity shows Medicare billing for the service more than tripled from 2001 to 2011, to 136,000 annually. One doctor in Florida billed for about 2,200 eyelid lifts in 2008, to the tune of approximately $800,000.
“There is no way that is anything other than crap,” says Ryan Stumphauzer, a former federal prosecutor in the Southern District of Florida and founding member of the Medicare Fraud Strike Force, according to the center’s report.
Medicare won’t pay for the sometimes-cosmetic procedure unless the physician documents a test to examine the patient’s vision and results that show “drooping skin significantly compromises a patient’s eyesight,” the report states. “The exam usually involves lifting a patient’s eyelids with tape and comparing their vision results to tests performed without tape.”
Some Medicare administrative contractors (MACs) are taking notice of the higher rates and performing audits. For example, from June through August 2012, Palmetto GBA reviewed 98 claims in southern California,
denying 62.4% of them. Of those, 92% were for missing or incomplete documentation.
For tips to ensure your documentation will withstand MAC scrutiny – and for alerts about which claims are drawing the most attention – subscribe to
Medical Practice Compliance Alert.