NCSLHA 2014 - Coding - NCSHLA · S1001: Deluxe item, patient notified ! May help with upgrades ! Need to determine how each private payer recognizes and reimburses this code !

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Revisiting the Most Common Coding and Reimbursement

Issues Plaguing Audiology Today Kim Cavitt, AuD

Audiology Resources, Inc.

North Carolina Speech Hearing Language Association September 20, 2014

Disclosures

S  Financial S  Audiology Resources, Inc. (Ownership) S  Academy of Doctors of Audiology (Consultant) S  Michigan Academy of Audiology (Consultant)

S  Non-Financial S  President-Elect, Academy of Doctors of Audiology S  Vice-Chair, State of Illinois Board of Speech Pathology and

Audiology S  Committee member, Audiology Quality Consortium, American-

Speech-Language-Hearing Association and Academy of Doctors of Audiology

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Hearing Aid Coding

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Hearing Aid Codes

92590: Hearing aid examination and selection; monaural

92591: Hearing aid examination and selection; binaural

92592: Hearing aid check; monaural

92593: Hearing aid check; binaural

92594: Electroacoustic evaluation for hearing aid; monaural

92595: Electroacoustic evaluation for hearing aid; binaural

HCPCS “S” Codes

S  S1001: Deluxe item, patient notified S  May help with upgrades S  Need to determine how each private payer recognizes and

reimburses this code

S  S0618: Audiometry for hearing aid evaluation to determine level and degree of hearing loss S  Not for Medicare S  Need to determine how each private payer recognizes and

reimburses this code

V5008: Hearing screening V5010: Assessment for hearing aid V5011: Fitting/orientation/checking of hearing aid V5014: Repair/modification of hearing aid V5020: Conformity evaluation

HCPCS Codes

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HCPCS Codes

V5050: Hearing aid, monaural, in the ear

V5060: Hearing aid, monaural, behind the ear

V5130: Binaural, in the ear

V5140: Binaural, behind the ear

HCPCS Codes

V5242: Hearing aid, analog, monaural, CIC

V5243: Hearing aid, analog, monaural, ITC

V5248: Hearing aid, analog, binaural, CIC

V5249: Hearing aid, analog, binaural, ITC

HCPCS Codes

V5170: Hearing aid, CROS, in the ear

V5180: Hearing aid, CROS, behind the ear

V5200: Dispensing fee, CROS

V5210: Hearing aid, BICROS, in the ear

V5220: Hearing aid, BICROS, behind the ear

V5240: Dispensing fee, BICROS

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HCPCS Codes

V5254: Hearing aid, digital, monaural, CIC

V5255: Hearing aid, digital, monaural, ITC

V5256: Hearing aid, digital, monaural, ITE

V5257: Hearing aid, digital, monaural, BTE

HCPCS Codes

V5258: Hearing aid, digital, binaural, CIC

V5259: Hearing aid, digital, binaural, ITC

V5260: Hearing aid, digital, binaural, ITE

V5261: Hearing aid, digital, binaural, BTE

HCPCS Codes

V5090: Dispensing fee, unspecified hearing aid V5110: Dispensing fee, bilateral V5160: Dispensing fee, binaural V5241: Dispensing fee, monaural hearing aid, any type

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HCPCS Codes

V5268: Assistive listening device, telephone amplifier, any type

V5269: Assistive listening device, alerting, any type

V5270: Assistive listening device, television amplifier, any type

V5271: Assistive listening device, television caption decoder

V5272: Assistive listening device, TDD

V5273: Assistive listening device, for use with cochlear implant

V5274: Assistive listening device, not otherwise specified

HCPCS Codes

S  V5281: Assistive listening device, personal FM/DM system, monaural (1 receiver, transmitter, microphone), any type

S  V5282: Assistive listening device, personal FM/DM system, binaural (2 receivers, transmitter, microphone), any type

S  V5283: Assistive listening device, personal FM/DM neck, loop induction receiver

S  V5284: Assistive listening device, personal FM/DM ear level receiver

HCPCS Codes

S  V5285: Assistive listening device, personal FM/DM, direct audio input receiver

S  V5286: Assistive listening device, personal personal bluetooth FM/DM receiver

S  V5287: Assistive listening device, personal FM/DM receiver, not otherwise specified

S  V5288: Assistive listening device, personal FM/DM transmitter assistive listening device

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HCPCS Codes

S V5289: Assistive listening device, personal FM/DM adaptor/boot coupling device for receiver, any type

S V5290: Assistive listening device, transmitter microphone, any type

HCPCS Codes

V5264: Ear mold/insert/not disposable, any type

V5265: Ear mold/insert/disposable, any type

V5275: Ear impression, each

HCPCS Codes

V5266: Battery for use in hearing device V5267: Hearing aid or assistive listening device/supplies/

accessories, not otherwise specified

V5298: Hearing aid, not otherwise classified

V5299: Hearing service, miscellaneous

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Contracting

Receive Provider Agreement

S  Read the entire agreement and review the fee schedule S  Pose questions where you lack answers

S  Things to consider: S  What products am I participating with? Medicare Advantage? Medicaid?

HMOs? S  Does it allow for balance billing or patient upgrades for hearing aids? S  Can certain services we carved out of the contract? S  Termination terms S  Renewal terms

S  “Evergreening” of contract S  Medical necessity S  Requirements for standard processes and procedures for all patients

Receive Provider Agreement

S  Things to consider: S  Means of provider notification of substantive changes to the agreement S  Requirements for standard fee schedule S  Claims filing requirements S  Requirements related to consistency in pricing and policies S  Clinic hour requirements S  Does the fee schedule address all of the items and services you provide? S  How does the contract address:

S  S1001 S  S0618 S  92700 S  V5298

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Fee Schedule

S  What the payer allows, per contract, for each specific item and service you provide S  Never accept less than you can afford

S  Do the benefits outweigh the costs S  Be careful of:

S  Large hearing aid discounts S  “Fitting fee only” arrangements S  Invoice plus arrangements

S  Requirements to provide the manufacturer invoice S  Sometimes it is a better business decision to be out-of-

network providers

CAQH

S  Credentialing clearinghouse

S  Free

S  http://www.caqh.org/

S  To participate: S  Must be a contracted provider with a least one of the

CAQH participating payers S  Must be invited by CAQH once registered

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Hearing Aid Reimbursment

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Third-Party Reimbursement

•  Know the terms of your third-party contracts and fee schedules •  If you do not like it, you have no one to blame but YOU! You agreed to these terms

and fees!

•  Good reimbursement begins and ends with you

•  Starts from the minute the patient calls

•  Accountability is key

•  Verification is required EVERYTIME! •  Have to ask the right questions •  Hearing aids

•  BAHA •  Cochlear implants

Insurance Verification

S  Most important question: Can the patient have out of pocket expense other than co-pays, deductibles and co-insurance? Can they upgrade?

S  Are they eligible

S  Know your deductibles!

S  Do not discount aids billed to third-party carriers. Have all marketing provide a disclaimer to this effect.

Insurance Verification

S  Please ask the third-party payer if you are to bill “usual and customary” or MSRP for this case.

S  Consider unbundling the charges as it may push about $200-300 to patient responsibility. Have the patient pay the cost of the hearing aid evaluation and earmold at the date of fitting. S  Restrict the level of product provided

S  If a carrier states that they pay a “maximum of x dollars” but do not specifically define a benefit amount, assume the $500 rule as, on many occasions, they will not actually pay the maximum (the maximum would typically apply to a digital CIC).

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The Down Low on Waivers/Patient Notification

•  CANNOT USE IF NOT ALLOWED BY CONTRACT!!! •  Otherwise, you will be in violation and, if a patient pushes back, you will have

to refund them

•  Think about ethics here

•  Patient Notification •  Use to notify and bill patient for non-covered services

•  Upgrade Waiver •  BCBS •  Must provide an aid (standard) at no charge to patient

•  Patient can upgrade if they so choose and pay the difference between the allowable and usual and customary

The Down Low on Waivers/ Patient Notification

•  Insurance Waiver •  Patient waives their insurance benefit •  They do not bill their insurance and you do not bill

their insurance •  Rarely happens

Hearing Aid Verification Scenarios:

S  Scenario 1: You contact the third-party payer and completes the insurance verification form in full. Per the third-party payer, you are allowed to balance bill the patient for the difference between the insurance coverage/allowable amount and the your usual and customary charge. S  This one is easy!!!

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Hearing Aid Verification Scenarios:

S  Scenario 2: You contact the third-party payer and complete the insurance verification form in full. Per the third-party payer, you are not allowed to balance bill the patient for the difference between the insurance coverage/allowable amount and your usual and customary charge.

Scenario #2

S  You must restrict product cost to an aid whose invoice cost is less than $300 per aid maximum.

S  The patient has no out of pocket expense in this scenario (except for unmet co-pays or deductibles).

S  You must accept the negotiated rate as payment in full.

Scenario #2

S  I strongly encourage you to be honest with the patient about the situation (i.e. “the negotiated rate is less than my cost for more advanced products”).

S  The patient then has four options: S  Get a more basic hearing aid(s) paid in full by their third-party payer. This is what most patients

prefer. S  Refer the patient to a third-party administrator you is contracted with, such as HearPO or Epic,

that IS a contracted provider for this plan, is allowed to bill the funded portion of their plan and is also allowed to balance bill the patient.

S  Go elsewhere and try to find another provider who will do this for them (in many cases out of network providers would be allowed to balance bill the patient).

S  Have the patient sign a completed insurance waiver. In this case, they are waiving their insurance coverage and you, as the provider, will not be submitting a claim to their carrier. Please ensure that the patient gets an original copy of their bill or sale and the insurance waiver in the event they attempt to bill their carrier themselves.

S  If the patient proceeds with Option #1, the patient should pay any co-insurance amounts (based upon usual and customary rates) and deductible amounts (up to the usual and customary cost of the aids) on the date of the fitting.

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When Dealing with Hearing Aids in a Third-Party World, Please Consider....

•  You MUST have a working knowledge of ALL of your contractual obligations and the fee schedules of each payer

•  The insurance verification form and process is completed prior to the hearing aid evaluation. If possible, the insurance information should be gathered at the time the hearing aid evaluation is scheduled.

•  Please also make sure that the patient pays all outstanding deductibles, co-pays, and percentages of responsibility on the date of fitting, as well as any patient responsibility they may have. You want to be in a position to refund money and not trying to collect outstanding monies from the patient.

•  You must get your cost of goods as low as possible •  No manufacturer is irreplaceable

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The Wonderful World of Medicare

CMS Audiology Policies

S  Update to Audiology Policies S  Effective October, 2008 # S  http://www.cms.gov/Regulations-and-Guidance/Guidance/

Transmittals/downloads//R84BP.pdf

S  Revisions and Re-Issuance of Audiology Policies S  Effective September, 2010 S  http://www.cms.gov/Outreach-and-Education/Medicare-

Learning-Network-MLN/MLNMattersArticles/downloads//MM6447.pdf

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CMS Audiology Policies

S  Address: S  “Incident to” billing S  Required physician orders S  Treatment Services S  Computerized audiometry S  Role of technicians and their supervision requirements S  Role of students, including but not limited to, the final year extern

and their supervision requirements S  Medical necessity S  Billing of technical and professional components S  Documentation S  92700 S  “Opt Out” (audiologist cannot opt out of Medicare)

Medical Necessity

S  “Under any Medicare payment system, payment for audiological diagnostic tests is not allowed by virtue of their exclusion from coverage in section 1862(a)(7) of the Social Security Act when: S  The type and severity of the current hearing, tinnitus or balance

status needed to determine the appropriate medical or surgical treatment is known to the physician before the test; or

S  The test was ordered for the specific purpose of fitting or modifying a hearing aid”.

Medical Necessity

S  “Examples of appropriate reasons for ordering audiological diagnostic tests that could be covered include, but are not limited to: S  Evaluation of suspected change in hearing, tinnitus, or balance; S  Evaluation of the cause of disorders of hearing, tinnitus, or balance; S  Determination of the effect of medication, surgery, or other treatment; S  Reevaluation to follow-up changes in hearing, tinnitus, or balance that may be caused by established

diagnoses that place the patient at probable risk for a change in status including, but not limited to: otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Meniere’s disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions;

S  Failure of a screening test (although a screening test is non-covered); S  Diagnostic analysis of cochlear or brainstem implant and programming; and S  Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices”. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

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Documentation

S  “Documentation for Orders (Reasons for Tests). S  The reason for the test should be documented either on the order, on

the audiological evaluation report, or in the patient’s medical record. (See subsection C. of this section concerning reasons for tests.)

S  Documenting skilled services. When the medical record is subject to medical review, it is necessary that the record contains sufficient information so that the contractor may determine that the service qualifies for payment. For example, documentation should indicate that the test was ordered, that the reason for the test results in coverage, and that the test was furnished to the patient by a qualified individual. S  Records that support the appropriate provision of an audiological

diagnostic test shall be made available to the contractor on request”.

Physician Order Requirements

S  Needed for each incident of care

S  Does not guarantee medical necessity

S  Should state “audiologic and/or vestibular evaluation” S  Should avoid the term “hearing aid”

S  For audiologists, tests do not need to be individually listed

S  Delivery methods:

S  Hand delivered, faxed or mailed S  E-mailed S  Telephone

S  Avoid this option

S  http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=233&name=Palmetto+GBA+(11502%2c+MAC+-+Part+B)&DocType=All&ContrVer=1&CntrctrSelected=233*1&LCntrctr=233*1&bc=AgACAAIAAAAAAA%3d%3d&#ResultsAnchor

S  Intraoperative Monitoring

S  Vestibular Testing S  Also affects 92557 S  Palmetto

Local Coverage Determinations for North Carolina

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§  PQRS is a program designed to improve the quality of care to Medicare beneficiaries.

§  Audiologists who bill Medicare Part B beneficiaries must participate in 2014 to avoid a 2% reduction in Medicare reimbursement in 2016. §  Does not apply to Part A hospital or skilled nursing

facilities

Audiology Physicians Quality Reporting System (PQRS)

S  Until December 31, 2014, a 0.5% bonus will be given for all Medicare eligible cases when reporting on 50% of eligible measures S  You can avoid the penalty by qualifying for the incentive

PQRS Incentive

PQRS Penalty

S  Until December 31, 2014, the penalty will be avoided if each provider reports on, for all Medicare eligible cases, on 50% of eligible measures

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S Measure #261: Referral for otologic evaluation for patients with acute or chronic dizziness

S Measure #130: Documentation and verification of current medications in the medical record

S Measure #134: Screening for clinical depression and follow-up plan

2014 PQRS Measures for Audiology

S  Measure #188 (Congenital and traumatic deformity of the ear) was retired for 2014.

S  Do not report on this measure as of January 1, 2014!

Eliminations

S  CPT Codes S  92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547,

92548, 92550, 92557, 92567, 92568, 92570, 92575 S  Patients that have any of these CPT codes (as well as the

ICD-9-CM codes below) fit into the measure’s denominator (the eligible patients for a measure)

S  IDC-9 Codes S  780.4 OR 386.11 # S  Patients that have any of these IDC-9-CM codes (as well as

CPT codes above) fit into the measure’s denominator (the eligible patients for a measure)

Codes for Referral for Acute or Chronic Dizziness

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S  G8856: Referral to a physician for otologic evaluation

S  G8857: Patient is not eligible for the referral for otologic evaluation (i.e. patients who are already under the care of a physician for acute or chronic dizziness)

S  G8858: Referral to a physician for an otologic evaluation not performed, reason not specified

Codes for Referral for Acute or Chronic Dizziness

S  CPT Codes S  92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557,

92567, 92568, 92570, 92585, 92588, 92626 S  Patients that have any of these CPT codes (as well as the

ICD-9-CM codes below) fit into the measure’s denominator (the eligible patients for a measure)

S  IDC-9 Codes S  None specified (so all included) S  Patients that have any of these IDC-9-CM codes (as well as

CPT codes above) fit into the measure’s denominator (the eligible patients for a measure)

Codes for Documentation of Current Medications

S  G8427: List of current medications (includes prescription, over the counter, herbals, vitamin/dietary supplements) documented by the provider, including drug name, dosage, frequency, and route

S  G8430: Provider documentation that patient not eligible for medication assessment

S  G8428: Current medications (includes prescription, over the counter, herbals, vitamin/dietary supplements) with drug name, dosage, frequency, and route not documented by provider, reason not specified

Codes for Documentation of Current Medications

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S  This is not just about PQRS but also important to patient care, regardless of your practice setting and clinical focus

S  Many patient now carry this list with them, so do not forget to ask at intake S  You can make a copy of their list, verify whether it is

current, sign it, date it, and place it in the medical record.

Important Considerations Regarding Documenting Current Medications

S  This measure is 100% VOLUNTARY - it will not assist you in qualifying for the incentive or avoiding the penalty.

S  CPT Codes S  92557, 92567, 92568, 92625, 92626 S  Patients that have any of these CPT codes (as well as the ICD-9-CM

codes below) fit into the measure’s denominator (the eligible patients for a measure)

S  IDC-9 Codes S  None specified (so all included) S  Patients that have any of these IDC-9-CM codes (as well as CPT codes

above) fit into the measure’s denominator (the eligible patients for a measure)

Codes for Screening of Clinical Depression

S  G8431: Positive screen for clinical depression using an age appropriate standardized tool and a follow-up plan documented

S  G8510: Negative screen for clinical depression using an age appropriate standardized tool and a follow-up plan documented

S  G8433: Screening for clinical depression using an age appropriate standardized tool not documented, patient not eligible/appropriate

S  G8432: No documentation of clinical depression screening using an age appropriate standardized tool

S  G8511: Positive screen for clinical depression using an age appropriate standardized tool documented, follow-up plan not documented, reason not specified

Codes for Screening of Clinical Depression

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S  Report on Measure #134 when: S  Allowed by your state licensure law (when deemed

within the scope of practice of an audiologist within your state; determined through written contact with your state licensing board)

S  You are appropriately trained and competent to perform a depression screening using a standardized tool AND create a patient plan of care based upon the results of the screening

S  A follow-up plan of care is created, implemented and documented in the medical record

Important Factors Related to the Clinical Depression Measure

S  A sample 1500 claim form, with PQRS, is available at http://www.asha.org/advocacy/audiologypqri/ S  ICD-9 codes are placed in box 21 S  CPT codes are placed in box 24D S  G-codes are placed in box 24D following the CPT code

Submitting PQRS

S  Report on Measure #261 (Dizziness) on at least 50% of each provider’s Medicare claims which contain the diagnosis codes of 780.4 (Dizziness) or 386.11 (BPPV).

S  Report on Measure #130 (Documentation of current medications) on at least 50% of each provider’s Medicare claims where they bill for a hearing test, caloric testing, tympanometry, auditory brainstem response testing, comprehensive otoacoustic emissions, and/or cochlear implant/auditory osseointegrated device candidacy testing.

PQRS: Avoiding the Penalty and Qualifying for the Incentive

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The Depression Measure (#134) is optional (you can avoid the penalty and qualify for the incentive without ever

reporting this measure!

PQRS: Depression Measure

What Happens in 2016 Matters Now…

S  Beginning January 1, 2015, the voluntary incentive program is slated to end and a reimbursement adjustment will be made if eligible professionals (such as audiologists) do not report on at least one audiology PQRS measure one time.

S  The 2015 reduction is based on reporting in 2013 S  In 2015, the reduction is 1.5% of all 2013 eligible claims S  In 2016, the reduction is 2.0% of all 2014 eligible claims

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Pricing

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Pricing Strategies

•  Most pricing strategies I see in this industry are based on NOTHING

•  You CANNOT be afraid to charge for your time and services

•  You are NOT a hearing aid dispenser

Pricing Strategies

•  All prices should reflect: •  An understanding of your personal breakeven

analysis •  An understanding of your third-party payer fee

schedules •  An understanding of the prevailing rates in the area

Breakeven Analysis

•  Breakeven analysis is what does your practice need to bring in per hour per full-time equivalent provider to cover your expenses (salary, overhead, calibration, fixed costs, benefits, annual fees, etc.) •  Hearing aid procurement costs are not here as they are variable

•  You want to add a “profit” amount to this

•  This is the minimum you can charge

•  You base your fees for items and services where no fee schedule exists •  Based upon the time required to complete the procedure

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Third-Party Fee Schedules

•  Be aware of the third-party fee schedule amounts

•  You do not want to charge less than you could have collected

•  Must have a standard fee schedule for all patients •  If you charge one you must charge all

Prevailing Rates

•  Least important aspect as you must charge what you need to cover your overhead and you do not want to charge less than you could have collected

•  Just because your competitors are idiots does not mean you have to be one too!

Pricing Diagnostic/Treatment Services

•  Compare break-even rate plus profit to that of your highest third-party payer for each code

•  Consider how much time you schedule each procedure for

•  Want to at least be 120% of Medicare rate but try to avoid being more than 200% of Medicare

•  NEVER charge what you expect to receive!!

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Pricing Hearing Aid Services

•  What is your breakeven plus profit amount?

•  How much time do you schedule for each hearing aid procedure?

•  What is the prevailing third-party reimbursement rate?

Polling

S  How many of you unbundle?

Bundling

•  You “bundle” all of our hearing aid product and service costs, as well as our professional fees, under one, singular price (and code)

•  You do not charge separately for the hearing aid evaluation/consultation and, as a result, receive no payment if a patient does not proceed with amplification.

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Bundling

•  Pros •  Easy •  What everyone else does

•  Cons •  Not how insurance pays for items and services •  Prices are not transparent •  Increases patient costs for many •  Does not reflect your professional time •  May be collecting less than you need to receive to cover

the “average” patient

Bundling

S  Billing all items and services associated with the evaluation, fitting and management of a hearing aid, as well as its related goods, under one code on the date of fitting

Bundled Package Includes:

S  Hearing aid evaluation

S  Earmold impression, if required

S  Electroacoustic evaluation, if performed

S  Hearing aid itself

S  Fitting and orientation

S  Dispensing fee

S  Verification, if performed

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Bundled Package Includes:

S  Verification, if performed

S  Dome or custom earmold, if required

S  Batteries

S  Accessories, if provided

S  Manufacturer warranty

S  Loss and damage coverage

S  One year to lifetime of follow-up hearing aid office visits, checks, in-house repairs, and cleanings

Unbundling

•  Charging separately for each item or service as it occurs

•  Breaking the “bundled” cost into each individual piece or aspect of service

Unbundling: Pros

✦  Collecting the amount you need to cover your costs and make a profit (price based on something tangible)

✦  Price better reflects actual financial needs

✦  Potential for increased revenues long-term

✦  Allows for increased reimbursement with most managed care situations

✦  Makes you price competitive

✦  Allows for some potential marketing advantages

✦  Allows for pricing for internet or EBay purchases

✦  They pay everything but the cost of the hearing aid itself

✦  You care less about where the aid comes from

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Unbundling:Cons

✦ Potential short-term reduction in revenues

✦ Does not work as well with managed care plans where you have to take a large, provider discount or plans with defined warranty/coverage terms (i.e. EPIC or HearPO)

✦ Will need to change office policies and procedures

✦ Have to collect money from patient can be comfortable with that

✦ Will need to change marketing program

Unbundled Pricing Model: HAE

✦ On the date of the hearing aid evaluation, you bill the hearing aid evaluation (92590/1 or V5010; whichever pays more for your average third-party hearing aid contract) to the third-party payer or patient, even if they do not proceed with amplification.

✦  Most third-party payers who cover hearing aids cover hearing aid evaluations!

✦  You would also bill for the earmold impression (V5275) if a custom earmold is warranted

Unbundled Pricing Model: Hearing Aid Fitting

✦  On the date of fit, you would bill the following codes to the patient or the third-party payer:

✦  V52--: The code for the hearing aid itself

✦  V5---: Dispensing fee

✦  92594/5:Electroacoustic analysis (if performed) with date service is performed

✦  V5011: Fitting and orientation

✦  V5020: Conformity evaluation (if you perform real-ear and/or functional gain testing)

✦  V5264: Earmold (custom) or V5265 Dome (disposable earmold)

✦  V5266: Batteries (per battery)

✦  V5267: Accessories

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Unbundled Hearing Aid Pricing Model: Follow-up During Trial

S  Bill 92592/3 or V5011 on the date of each follow-up visit (if billing third party payer)

S  If private pay patient, you may opt to bill these visits on the date of the fitting

Unbundling: End of Trial

✦ On this date, the patient has three choices:

✦  Exchange the hearing aid

✦  Return the hearing aid for credit

✦  Keep the hearing aid and “pay as you go” for service

✦  Keep the hearing aid and purchase a service package

Unbundling: Exchange

•  What was the reason for the exchange?

•  Can charge a patient a second fitting fee

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Unbundling: Return for Credit

✦ As allowed by State law, you would refund the patient only the cost of the hearing aid itself (you would retain all other monies as the services were provided)

Unbundling: Pay As You Go

✦ Have a fee established for every item or service and charge a patient or their third-party payer (if their benefits have not been exhausted) every time the item is provided or the service is performed

✦ Fees based upon breakeven analysis and/or cost of goods

✦ Nothing is free or no charge, unless associated with a targeted marketing event

Unbundling: Service Package

✦ This is the service you are currently providing at no charge once the aids are fit and accepted

✦ Think of it as the difference between your current bundled fees and the unbundled package cost

✦ A patient pays you a fixed rate per aid (based upon the breakeven analysis) for managing their hearing aids and services for a given period of time

✦ Base this on your “average” patient

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S

Billing

Billing 101: The Facts

S  It is ALL about PROCESS and POLICIES

S  Providers complete the testing, write the report and fill out the superbill

S  Data is power!!! S  Complete a superbill on every patient you see, even no charge visits

S  Someone has to collect patient responsibility on the date of service S  Billing costs YOU money!!!

S  Office staff takes the superbill information, submits the claim, and monitors payment

Billing 101: The Facts

S  Claims should be posted within two business days

S  Payments should be posted daily

S  No one should be able to write off sums over $100 other than the manager or owner

S  Stop seeing patients who owe you money

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Billing 101: The Facts

S  You must invest in staff training and materials S  Office management or billing software

S  The days of paper claims are almost over!!!

S  Manuals S  You will have to make an investment in ICD10

S  Training

S  You must have consistent, no exceptions financial policies S  STOP GIVING IT AWAY!!!! S  Should be in writing and available

Billing Checks and Balances:

S  Owners and managers, regardless of your work setting, must monitor accounts receivable and accounts payable S  Monthly, at a minimum S  Collect patient responsibility on date of service

S  Credit card on file is an option as well

Questions

S  Attendees of today’s course may contact me with questions for the next 30 days at no charge

S  Current ADA members may contact me any time at no charge

S  [email protected]

S  773-960-6625