ASE Joins Letter of Support for the Protecting Approved Care Act

On October 23, ASE joined the Alliance of Specialty Medicine in a letter to Representatives Greg Landsman and Bob Onder expressing support for H.R. 10394, the Protecting Approved Care Act. The bill would prevent Medicare Advantage plans from reversing coverage decisions after prior authorization has been granted, barring denial for lack of medical necessity, reopening an approved determination except for good cause or fraud, or changing a claim’s billing code to reduce payment except under limited exceptions.

This protection is directly relevant to echocardiography practices that rely on Medicare Advantage prior authorization for advanced cardiac imaging studies. Without safeguards like those in H.R. 10394, a plan could approve an echocardiogram or related study and later reverse or down-code that approval after the service has already been furnished, leaving practices exposed to unexpected denials or reduced payment for medically necessary care they performed in good faith reliance on the plan’s own authorization.