Reimbursement

Reimbursement

Academy provides comments to CMS on proposed rules for the Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System

The Academy submitted comments to the Centers for Medicare and Medicaid (CMS) on the proposed CY 2020 Medicare Physician Fee Schedule (PDF).  Academy comments provide specific feedback on Computerized Dynamic Posturography (CPT Codes 92548 and 92549) as well as on Auditory Function Evaluation (CPT Codes 92626 and 92627).  In addition, Academy comments urge CMS to reconsider its proposed restructuring of Evaluation and Management (E

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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2020 OPPS Rule: Audiology Impacts

2020 Final APCs for Audiology Codes: APC assignments, status indicators, and reimbursement amounts for audiology codes. 

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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

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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)

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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

Presenting Audiology Codes for Valuation

New and revised codes describing auditory-evoked potential (AEP) and vestibular-evoked myogenic potential (VEMP) testing were presented during last week’s American Medical Association’s Relative Value Update Committee meeting. The codes will be available to audiologists in 2021.