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Reimbursement

Reimbursement

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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.

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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

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CODING AND REIMBURSEMENT | Demystifying CPT Code 92700

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

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CODING AND REIMBURSEMENT | CMS Includes Audiologists in the QPP

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

Hearing Aids Covered Under Maryland Medicaid

Recent changes in the state Medicaid coverage will allow all Medicaid-eligible adults to obtain hearing aids, cochlear implants, or other oseointegrated heating devices. The changes that went into effect in October of 2018 were on WTOP on January 9, 2019. 

Previously such coverage was limited to children and adults under the age of 21. It is also noteworthy that the process of determining candidacy and procuring the appropriate treatment starts with the PCP but explicitly involves the audiologist. 

Reference

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Questions and Answers about Participating in MIPS for 2019

Question 1:  How do I know if I have to participate in the Quality Payment Program (QPP)?

Answer:  Only a few audiologists will have to participate in the QPP – because few audiologists have more than $90,000 in allowed charges.  You can go to the CMS website at https://qpp.cms.gov/participation-lookup to determine if you are required to participate in the QPP based on old data but the final determination for 2019 will be bases on your 2019 billing figures.