Introduction
The American Academy of Audiology (the Academy), together with the American Speech-Language-Hearing Association (ASHA), continuously reviews the CPT code set applicable to audiologists. The goal is to ensure that audiologists have appropriate codes to report that accurately describe and reflect the services they perform for patients.
Topic(s): Coding, Reimbursement, audiology
Pricing Thoughts Overview
- How do you set your fees?
- How much is too much and how much is not enough?
For diagnostics, some audiologists may look at the fee schedule provided by third parties such as Medicare and wonder if those fees should be the fees for all patients.
For products, audiologists may use manufacturers’ suggested retail pricing to determine how much should be charged.
Topic(s): Coding, Reimbursement, audiology
The Centers for Medicare and Medicaid Services (CMS) issued the final 2021 Medicare Physician Fee Schedule (MPFS) on December 2, 2020. Unfortunately, CMS failed to provide relief from a significant shift in physician and non-physician payments slated to take effect on January 1, 2021. This change is estimated to impact audiology services by -6 percent.
Introduction to the Medicare Advantage Program
The Medicare Part C Program was developed following passage of the Balanced Budget Act of 1997 and went into effect in January of 1999. With identified gaps in coverage for Medicare beneficiaries, the addition of an optional Medicare program permitted the Centers for Medicare and Medicaid Services (CMS) to contract with private or public agencies to provide additional Medicare options for beneficiaries who wished to seek coverage in addition to original Medicare’s Part A and B benefits.
Topic(s): Coding, Reimbursement, audiology, Hearing Aids, Centers for Medicare and Medicaid Services (CMS)
On October 1, 2016, new ICD-10-CM codes were released that increase the specificity of hearing loss codes, applying specifically to coding the type of hearing loss when it differs between ears. Previously, when the types of hearing loss differed between ears, audiologists were required to code an unspecified type of hearing loss for each ear and could not specify right versus left ears in this scenario (i.e. sensorineural hearing loss, unspecified; conductive hearing loss, unspecified; mixed hearing loss, unspecified).
Topic(s): Coding, Reimbursement
Did you know that at the end of 2016, the Physician Quality Reporting System (PQRS) ended and was replaced by CMS’ new Quality Payment Program (QPP)? This means that 2016 was the final year in which providers, including audiologists, were eligible to participate in the PQRS program.
Topic(s): Coding, Reimbursement
Many of you may be familiar with, or may have even used, the Academy’s e-mail box for submitting coding, reimbursement, and compliance-related questions. This centralized mailbox (reimbursement@audiology.org) allows the Academy’s Coding and Reimbursement Committee (CRC) to review and discuss all inquiries posed to the Academy. The CRC is able to research, discuss, and vet responses to questions received. Having a centralized system for answering questions serves many purposes.
Topic(s): Coding, Reimbursement, Advocacy
Members of the American Academy of Audiology’s Coding and Reimbursement Committee (CRC) and the Practice Policy Advisory Council (PPAC) often collaborate with other audiology organizations, including the American Speech-Language-Hearing Association (ASHA) and the Academy of Doctors of Audiology (ADA), to develop coding guidance based on frequently asked questions (FAQs). Most recently, the groups worked together to create guidance addressing various issues related to coding and reimbursement for audiology services.
Topic(s): Coding, Reimbursement
