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
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
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)
On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for 2018.The final rule addresses adjustments to the MPFS and other Medicare Part B payment policies, including changes in valuation for services and overall payment updates.
Topic(s): Coding, Reimbursement, vestibular evaluation, vestibular disorders, Centers for Medicare and Medicaid Services (CMS), Medicare Physician Fee Schedule (MPFS), Medicare, CPT - Current Procedural Terminology, Children's Health Insurance Program (CHIP), Medicare Access and CHIP Reauthorization Act (MACRA), Achieving a Better Life Experience (ABLE), American Medical Association (AMA), Relative Value Scale Update Committee (RUC), Physician Quality Reporting System (PQRS), Outpatient Prospective Payment System (OPPS), Quality Payment Program (QPP), Healthcare Common Procedure Coding System (HCPCS)
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
You may have received a notification to revalidate your Medicare enrollment, or heard others discussing Medicare revalidation, and were unsure what this process was, or if you were required to do anything. The Academy has put together some quick answers to your questions and links to resources to help you through the revalidation process.
Topic(s): Coding, Reimbursement, Medicare, Revalidation