Medicaid

Medicaid

CCHP Creates "COVID-19 Related State Actions" Resource

The Center for Connected Health Policy has created a resource which provides links to all state-related actions on telehealth that have been issued in response to the COVID-19 crisis. 

State Telehealth Resource Including Medicaid Reimbursement, Private Payer Laws, and Occupation-Specific Regulations  

The Center for Connected Health Policy has released a state telehealth resource that outlines state Medicaid reimbursement, the existence of any private payer laws, as well as any occupational licensing board specific regulations with regard to the provision of services via telehealth.  

Telehealth and Medicare/Medicaid

Medicare regulations do not currently recognize audiologists as eligible providers of telemedicine services. The Academy has long advocated to change this, and we are currently working with congressional leaders to seek inclusion of such a change in legislation moving forward to address the COVID-19 pandemic.

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COMPLIANCE | CMS Spotlight on Program Integrity and Provider Enrollment in Medicare, Medicaid, and CHIP

The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule that provides more authority for CMS to address fraud, waste, and abuse in federal health insurance programs including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The new rule aims to bolster the ability of CMS to fight fraudulent or other inappropriate activity before it happens and before providers are paid. 

Topic(s): Centers for Medicare and Medicaid Services (CMS), Medicare, Medicaid, Children's Health Insurance Program (CHIP), Office of General Inspector (OIG), secretary of health and human services, Provider Enrollment, Chain, and Ownership System (PECOS)

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Publication Issue: Audiology Today November/December 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)

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Publication Issue: Audiology Today July/August 2019

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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

Audiology Today Mar/Apr 2019…What’s Inside This Issue?

The editorial team and I are so happy to announce the content for this latest issue of Audiology Today. We are featuring a number of comprehensive, relevant, and interesting articles, as well as some short reads on public relations, coding and reimbursement, and audiology advocacy.

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CODING AND REIMBURSEMENT | Coding Update: Contralateral Routing Device

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

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Publication Issue: Audiology Today March/April 2019

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Medicare, Hearing Care, and Audiology: Data-Driven Perspectives

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