Insurance companies provide coverage for care, items and services that they deem to be “medically necessary.” Medicare defines medical necessity as “health-care services or supplies needed to diagnose or treat an illness or injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
Topic(s): American Medical Association (AMA), Medicare, Coding, Reimbursement
The American Academy of Audiology (the Academy) and others recently requested revisions for codes and code descriptors in the CROS/BiCROS family and Centers for Medicare and Medicaid Services approved many of the proposed changes. The groups requested the changes to reflect changes in CROS/BiCROS technology.
Topic(s): Audiologist, Binaural, Behind The Ear (BTE), Bilateral microphones with contralateral routing of signal (BiCROS), Contralateral Routing of Signal (CROS), In The Ear (ITE), Hearing Aids, Coding, Reimbursement, Practice Management, Medicaid, Medicare, Fitting, Sensorineural Hearing Loss
For the public at large, Medicare evokes the concept of a health insurance plan for the aged or retired population. Created in 1965 to provide a safety net for older individuals who faced substantial medical problems, the benefits available to Medicare beneficiaries are generally more limited than those available through private health insurance plans. Medicare has four parts (Medicare.com, 2018) as summarized in Table 1.
Topic(s): CPT - Current Procedural Terminology, Medicaid, Medicare, Coding, Reimbursement, Practice Management
There are Current Procedural Terminology (CPT) codes for almost every audiology procedure that exists. It is important to use the code that most accurately represents the audiologic procedure or service provided, which is often very straightforward.
Topic(s): Audiologist, Bone-Anchored Hearing Devices (BHADs), Bone-Conduction Implant (BCI), cervical vestibular-evoked myogenic potential (cVEMP), speech-in-noise, Tinnitus, saccade, Practice Management, Coding, Reimbursement, Compliance, CPT - Current Procedural Terminology
Under the final Quality Payment Program (QPP) rule for 2019, the Centers for Medicare and Medicaid Services (CMS) announced that audiologists will be considered “eligible clinicians” for QPP participation, effective January 1, 2019. The QPP replaced the Sustainable Growth Rate (SGR) formula that for many years served as the underpinning of Medicare provider payment.
Topic(s): Audiologist, Medicaid, Medicare, Coding, Compliance, Reimbursement, Practice Management