Coding plays a big role in getting reimbursed for audiology services provided to patients. Can you confidently navigate the process to get everything you’re owed from third-party payers? Learn some of the dos and don’ts along with key tips for success — and pitfalls to avoid — from Deb Abel, Au.D., manager of coding and contracting for Audigy.
Remembering the Basics
In health care, it’s no mystery why accurate coding is so important: If you don’t code correctly, you won’t get paid for your services.
Of course, errors can be remedied — ideally smoothing the way to eventual payment — but not before the potential delay keeps you from timely capturing third-party reimbursements along with any portions due from patients.
Delayed payments, especially for hearing aids, can be a hardship when your practice has already paid for the devices, causing a highly undesirable effect on your business’s accounts receivable.
When handling coding and benefits, remember the basics:
- Different payers may recognize different codes, so it’s vital to know which codes in the essential coding toolbox — the procedure codes (CPT), diagnosis codes (ICD-10-CM), and hearing-aid-related services and devices codes (HCPCS) — pertain to the payers with whom you’re contracted or enrolled.
- If a procedure isn’t on your fee schedule, it’s likely you won’t be paid for that procedure. Audiologists providing vestibular services likely encountered this with Medicare beneficiaries early this year when the new caloric codes debuted, so be sure to review the fee schedule periodically — especially in the event of a new procedure code.
- Medicare isn’t always ready on Jan. 1 when new CPT codes are effective, hence potential denials and delays related to new codes until the Medicare system then gets updated.
- The Medicare issue mentioned above serves as a good reminder to check your Medicare contractors for local coverage determination policies, which drive Medicare payments based on medical necessity and a physician order. Audigy can help with that.
- No hearing aid should leave an office without hearing aid verification completed with the applicable third-party payer. There’s a verification form on Audigy’s CEO™ to guide practices in asking essential questions, including the basic one: Can the patient share in the cost of an upgrade beyond their benefit?
Strengthening Your Code Game: 5 Dos and Don’ts
Keeping your code game strong requires avoiding common pitfalls, knowing when to say no, and understanding your contracts. For success, keep these dos and don’ts in mind:
- DO know how to code for the specific procedures and services your practice provides. As noted above, knowing how to code is essential to reimbursement. Audigy can help with any of your coding processes. You’ll need the reference number on each of your verification calls, as well as whom you spoke with and the date and time of your call.
- DO know each payer’s fee schedule. Though you bill everyone the same, each payer won’t pay the same. Not all payers recognize the same codes that you may commonly use, and those codes could be prone to a denial, ultimately leading to a payment delay.
- DO know what — if anything — must be written off. Many contracts prohibit balance billing. Commercial payers’ definition of balance billing is the difference between what was allowed and what was paid. It’s vital to know under what circumstances that applies: For diagnostic services only? For noncovered services? This demonstrates the importance of asking about the patient sharing in the cost of hearing technology upgrades and using the insurance companies’ terminology, ensuring everyone’s on the same page.
- DON’T dispense the hearing aid before verifying the benefit. No device should leave your office without your knowing who — the third-party payer or the patient — is responsible for each portion of what’s owed. Otherwise, you could lose thousands of dollars. Get the name of the person you spoke with, and note the time, date, and reference number of the call. All of this and more are included on Audigy’s verification form.
- DON’T be afraid to say no. If a given contract isn’t sustainable for your practice, don’t sign on the dotted line. To gauge whether a contract is beneficial to the health of your practice, however, you first have to know your hourly rate — even if you don’t charge by the hour. Some contracts pay a flat rate of some small amount, and you can’t bill the patient for the remainder. You couldn’t remain in business for long under that arrangement, so you wouldn’t sign that contract. If you’re worried the patient will go to your competition, let them. They too will learn that the payment is abysmal.
Getting paid for all the services your practice offers involves coding — regardless of who the payer is. Whether you have questions about specific codes and benefits, a third-party contract, or challenges related to Medicare, or if you need help determining your true hourly rate, we can help. Contact Audigy today.