Reimbursement

Reimbursement

News and Announcements

CMS 2015 Medicare Physician Fee Schedule Final Rule Released

Final Rule Changes to the 2015 Medicare Physician Fee Schedule

Hearing Aid Payment Verification Form

The Practice Compliance and Coding and Reimbursement Committees have created a hearing aid verification form for dispensing audiology offices. Read more…

 CMS 1500 paper claim form-must be used by April 1, 2014

CMS Medicare Physician Fee Schedule Final Rule Released
On Wednesday, November 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released its  2014 Medicare Physician Fee Schedule final rule. Although the rule is nearly one month late, it remains scheduled for implementation on January 1, 2014. Unless Congress acts prior to the December 31st deadline, sustainable growth rate (SGR) cuts and related payment adjustments will result in a net reduction in payment rates for audiologists and other health care professionals of approximately 24 percent. In addition to the SGR cut, the rule addresses key issues from the proposed rule, including changes to the Physician Quality Reporting System and Physician Compare website redesign. CMS has also released a  Fee Schedule Fact Sheet and a  PQRS Quality Fact Sheet.

Click here for the Academy’s detailed analysis of the CMS finalized Medicare Part B policy changes.

CMS Proposes Changes to Medicare Part B for 2014
On Monday July 8, 2013, the Centers for Medicare and Medicaid Services (CMS) issued the Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for  CY 2014 Proposed Rule. The proposal addresses changes to the Medicare physician fee schedule and other Medicare Part B payment policies. The proposed changes will be codified in a Final Rule in early November, 2013 and implemented on January 1, 2014. The Proposed Rule is open for comment through September 17, 2013, and the Academy will be submitting a detailed comment letter prior to the deadline.

Below is a summary of policy changes that members should be aware of:

  • Conversion Factor and Sustainable Growth Rate
  • The Physician Quality Reporting System (PQRS)
  • Physician Compare Website

Click here for a detailed summary of proposed Medicare Part B policy changes.

Academy Member Invited to Participate on Quality Measure Panel
The Academy is proud to announce that Tracy Murphy, Au.D., was recently invited to participate as a permanent member on a Technical Expert Panel (TEP) of multi-disciplinary health care professionals for the Quality Improvement Organization, Quality Insights of Pennsylvania. On May 10th, Dr. Murphy served as the sole audiologist on a panel to provide feedback regarding audiologists’ participation in reporting  Medicare Physician Quality Reporting System (PQRS) Measure # 134, Screening for Clinical Depression and Follow-Up Plan. Dr. Murphy has been providing services to patients at North Shore Audio-Vestibular Lab in Chicago, Illinois since the start of her professional career in 1993 and has taken an active role in bringing contemporary hearing and balance care to her patients. Dr. Murphy currently serves as a member of the Academy’s Coding and Reimbursement Committee

Academy Advocates for Aetna Coverage of E&M Codes for Audiology
In a recent letter to the Aetna health plan, the Academy addressed its concerns with Aetna’s December 2012 Clinical Payment, Coding, and Policy Change, which excludes audiologists from coverage and reimbursement for CPT Evaluation and Management (E&M) codes included in the range 99201-99499. The Academy requested the opportunity to meet with Aetna representatives and explain the audiology services provided during patient encounters that can expand beyond the performance of a diagnostic hearing or balance procedure. The Academy’s Coding and Reimbursement Department also reached out to the State Leaders Network to encourage grassroots and local advocacy by preparing a template letter and providing local contact information.  Read Academy’s letter to Aetna.

Critical Deadlines for Audiology Practices
Within the next twenty months, audiology practices will need to be prepared to comply with a number of Medicare and patient privacy deadlines. The Academy has all the educational resources you will need to learn how to comply. Read More…

New FM/DM Assistive Listening Device Codes Available in 2013
The Academy is excited to announce that CMS has created 10 new FM/DM assistive listening device codes for use beginning on January 1, 2013. These codes greatly enhance the billing options for all audiologists and especially those who work in pediatric settings. The inclusion of DM (digital modulation) will add longevity to the codes as technology advances. Members should note that the first two codes, V5281 and V5282, each represent complete FM systems (monaural and binaural, respectively). Read More ...

Academy Submits Response to CMS Regarding Medicare Fee Schedule Proposal
The Academy submitted its official comment letter to the Centers for Medicare and Medicaid Services (CMS) in response to the Medicare Physician Fee Schedule proposed rule. Among other comments, the Academy urged the Agency to continue to work with Congress in establishing a permanent and viable solution to the SGR formula that will result in fair payment for audiology services provided, requested that CMS reconsider the retirement of a hearing health quality measure encouraging medical evaluation for patients with a history of sudden or rapidly progressive hearing loss, and sought greater clarity and transparency regarding a proposal to apply a payment reduction when certain professionals, including audiologists, do not report on at least one quality measure under the Physician Quality Reporting System.  Read the Academy’s Comment Letter to CMS.

Expanded Coverage for UHC/Oxford OAE Policy
The Academy’s efforts have resulted in expanded audiology coverage for a restrictive United Health Care OAE policy. The Medical Director recently contacted the Academy to share the updated OAE policy. Read More...

Academy Submits Official Comment Letter to CMS Regarding ICD-10 Compliance Date

On May 17, 2012, the Academy submitted an official comment letter to CMS agreeing with the proposed ICD-10 compliance date of October 1, 2014 and urging CMS to consider an additional one-year delay to 2015 to provide time for audiologists to overcome the unique difficulties faced by small heath care practices.  Read More…

 Mass Claims Adjustment Issued for CPT code 92557 Under Palmetto LCD

Palmetto GBA, the Medicare Administrative Contractor for California, Nevada, and Hawaii, issued a notification on May 10, 2012 that "claim adjustments are to be completed for Common Procedural Terminology (CPT) Code 92557 for date of service on or after February 27, 2012, concerning Vestibular Function Testing."

This notification comes after an administrative error in processing claims for CPT code 92557 (comprehensive audiologic evaluation) under the Vestibular Function Testing (# 28314) Local Coverage Determination that went into effect on February 28, 2012.

Audiologists in this MAC area should expect to see payment for previously denied claims for 92557 in the near future. Read the Academy's April 19, 2012 reconsideration letter advocating for Palmetto to correct this error and reverse member denials.

Academy Sends Reconsideration Letter to Palmetto GBA in Opposition to 92557 Denials
In response to numerous calls and emails from the membership, the American Academy of Audiology is preparing a letter to Dr. Arthur Lurvey, Medical Director of Palmetto GBA  Jurisdiction.  Read More...

Academy Opposes Palmetto GBA Medicare Denials of CPT Code 92557
In response to numerous calls and emails from the membership, the American Academy of Audiology is preparing a letter to Dr. Arthur Lurvey, Medical Director of Palmetto GBA Jurisdiction. Read More ...

Medicare Provides Guidance on Vestibular Function Testing through Palmetto LCD
Certain states and regions of the country have new Medicare guidance on vestibular function testing through a local coverage determination (LCD) publicized by Palmetto GBA for its Jurisdiction 1 area.  The policy will be effective on February 27, 2012.  The Academy submitted a comment letter to Palmetto GBA on December 5, 2011 in response to an open notice and comment period for feedback on the policy. Academy member Alan Desmond, Au.D., provided significant scientific evidence and historical information to support the Academy's comment letter.  Several of the recommendations offered by the Academy were successfully adopted by Palmetto in this updated policy; however, the policy remains restrictive with respect to coverage for the rotational chair.

The Vestibular Function Testing LCD policy applies to the following areas of the country only: California, Nevada, Hawaii, American Samoa, Guam and Northern Mariana Islands.  Note that while Palmetto also covers NC, SC, VA, and WV (known as Jurisdiction 11), those states do not have any specific policy guidance on vestibular testing at this time.

A Guide to Itemizing Your Professional Services
Many audiologists are considering a change in their office billing practices to separately itemize the hearing instruments and the professional fees that are associated with the fitting and follow-up care for these devices. In response to member interest in this topic, a document was developed by the American Academy of Audiology as a guide to itemizing professional services, including detailed information on developing a business plan, dealing with insurance companies, and a break down of different hearing services claim submission examples for your review.  Read More…

Additional Academy Resources on Itemization/Unbundling 

Archived Reimbursement News and Announcments

Also of Interest

Hearing Aid Verification Form

November 20, 2014

Medicaid

June 03, 2014

Medicare

June 03, 2014