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Centers for Medicare and Medicaid Services (CMS)

Centers for Medicare and Medicaid Services (CMS)

Medicare Audiologist Access and Services Act of 2019 Introduced in the Senate

On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced the Medicare Audiologist Access and Services Act of 2019 (S.2446).

Audiology Today Sept/Oct 2019…What’s Inside This Issue?

Take a look at the table of contents and delve into these online articles, which you can now easily search by topic, title, or author. 

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AUDIOLOGY ADVOCATE | Time to Activate to Advocate

With the 116th Congress already over a quarter under way, the Government Relations Committee (GRC) urges Academy members to get involved. It is an exciting time for audiology, with the Academy actively working and collaborating with other organizations on new policy initiatives. The audiology voice in numbers is critical for the profession in advancing these initiatives.

Topic(s): Advocacy, Patient care, Hearing, Hearing Aids, Hearing Loss, Healthcare, Medicare Audiologist Access and Services Act, Centers for Medicare and Medicaid Services (CMS), Medicare, Balance/Vestibular, Adult

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CODING AND REIMBURSEMENT | When and Why to Modify

Billing modifiers were created to provide additional information to the payer about the performed procedure(s) and help describe and/or qualify the services provided. There are common modifiers used by commercial payers and the Centers for Medicare and Medicaid Services (CMS), that indicate to the payer that the services provided have been altered in a way that is different than the ascribed definition of the billing code. For example, a modifier should be used when all of the tests in a bundled code were not performed or when only one ear was tested.

Topic(s): Centers for Medicare and Medicaid Services (CMS), Medicare, Advance Beneficiary Notice (ABN), CPT - Current Procedural Terminology, Coding, Reimbursement, Practice Management, Patient care, Treatment

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Our Responsibility to Move Audiology Forward

A culture of quality is needed if we are to bring audiology into the spotlight and highlight our expertise in hearing and balance. Ritz-Carlton co-founder and former president Horst Schulze states that we can create transactions every day, but until we place the person next to us as the most important person in the world in that moment, we will never create an experience.

Topic(s): Professional, Patient care, Public Awareness, Centers for Medicare and Medicaid Services (CMS), Coding, Reimbursement, Practice Management, Hearing Assistive Technologies (HAT), Balance/Vestibular, Hearing Aids, Hearing Health Care

Author(s): 

Publication Issue: Audiology Today September/October 2019

CMS Issues Proposed Payment Rules for 2020

Late Monday, July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) posted the Proposed Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (OPPS) Rules for 2020. These comprehensive rules contain proposed policy and payment changes under the Medicare program.

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CODING AND REIMBURSEMENT | Potential Pitfalls in Cochlear-Implant Billing and Reimbursement

As cochlear implant awareness increases and more individuals receive cochlear implants, the demand for related audiological services is growing across the country. To meet this need, many audiologists have begun to add, or are considering adding, cochlear implant services to their practices. 

Topic(s): Coding, Reimbursement, Practice Management, Centers for Medicare and Medicaid Services (CMS), Medicare, Medicaid, Cochlear Implants (CI)

Author(s): 

Publication Issue: Audiology Today July/August 2019

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CODING AND REIMBURSEMENT | Advanced Beneficiary Notice of Noncoverage Use: Mandatory or Voluntary?

Understanding the correct use of the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 is important to ensure billing compliance for traditional Medicare (Part B). Audiologists may face challenges determining when Medicare covers a service and when an ABN is required. Federal law requires that providers, including audiologists, must notify a Medicare beneficiary in advance when a service that Medicare typically covers is likely to be denied and/or when the item or service is not considered by Medicare to be medically reasonable and necessary. The ABN meets this requirement.

Topic(s): Medicare, Coding, Reimbursement, Centers for Medicare and Medicaid Services (CMS), Balance/Vestibular

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CODING AND REIMBURSEMENT | New Medicare LCD Process—What You Need to Know

Local coverage determination (LCD) policies issued by Medicare administrative contractors (MACs) serve as the workhorse of Medicare coverage policy. About 90 percent of coverage determinations are made through LCDs. Coverage policies include a defined list of services the insurer will cover and specific exclusions. Medicare provides coverage of services that are determined to be “reasonable and necessary” for Medicare beneficiaries. If a specific item or service is not covered under an LCD, this does not mean it isn’t covered. Claims may be adjudicated on a case-by-case basis.

Topic(s): Coding, Reimbursement, Practice Management, Medicare, Medicaid, Local coverage determination (LCD), Medicare administrative contractors (MACs), Centers for Medicare and Medicaid Services (CMS)

Publication Issue: Audiology Today May/June 2019