With Medicare Changes Just Around the Corner, Are You Ready? What do audiologists need to know about the newly final 2020 Medicare Physician Fee Schedule? From fee-for-service changes to new codes and more, here are six things to expect in the new year:
1. Reimbursement Changes
Given there will be a slight increase in the conversion factor from $36.0391 to $36.0896, Medicare Part B providers may see an increase in Medicare payments. Unfortunately, the newly revised Current Procedural Terminology (CPT®) code 92548 will see an estimated 50% reduction.
The Centers for Medicare & Medicaid Services has long talked of moving away from the fee-for-service reimbursement approach and transitioning to the Merit Incentive Payment System (MIPS). This is occurring for physicians and will begin sometime beyond 2020 for audiologists.
Though not a change, low-volume thresholds are important to understand. You must report within MIPS if you’re a provider in all the following categories or part of an alternative payment model (APM):
- Provider who bills over $90,000 in services to Medicare AND
- Provided services to 200 or more beneficiaries AND
- Provided 200 or more services
This doesn’t affect a large number of audiologists across the country, but now’s a good time to determine whether your stats meet the reporting threshold: https://qpp.cms.gov/mips/how-eligibility-is-determined. At this writing, the 2020 eligibility year was not yet posted, but continue to check early in the year. Those practices that are part of the APM will also need to ensure their reporting responsibilities.
New Audiology Category Within MIPS
There will be a new category for audiology within MIPS, giving the discipline its own specialty set. In addition, certain measures will require reporting for those who are eligible for MIPS, including:
- #130: Documentation of Current Medications in the Medical Record
- #134: Screening for Clinical Depression and Follow-Up Plan
- #154 Falls Risk Assessment
- #155 Falls Risk Plan of Care
- #181: Elder Maltreatment and Follow-Up Plan (NEW)
- #182: Functional Outcomes Assessment (NEW)
- #226: Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention
- #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
- #318 Falls Screening for Future Fall Risk (NEW)
Audiologist may choose to report on these measures voluntarily.
The three new measures that assess the future of falls risk, elder maltreatment screen and follow-up plan, and functional outcome assessment will likely have CPT® codes associated with them as part of the measure, but these were not included in the MPFS final rule. They’ll likely be forthcoming early in 2020.
The new category reflects a growing recognition of audiologists’ value within the health care system and within Medicare, a promising development especially as other payers look to the agency for guidance. As more information is known, this will be shared with Audigy and Audigy Medical members.
Clarified CPT® Coding
A few CPT® codes are being updated and will be effective Jan. 1, 2020:
- CPT® code 92626 — currently involving evaluation of auditory function for candidacy or post-operative status of surgically implanted devices or other auditory treatment interventions, first hour — will apply only to the pre- or post-operative status of a surgically implanted device. It was always a time-based code and will remain so. Add-on code 92627 can be used for any ensuing 15-minute increments. Check with your payers to see if there is a limit on the number of units that can be billed.
- CPT® code 92548 — applicable especially to practices that perform vestibular testing with computerized dynamic posturography (CDP) — will change to CDP-SOT. The code will be used to report six conditions when employing CDP, including eyes open, eyes closed, visual sway, platform sway, eyes closed position or platform sway, and platform and visual sway. In addition to testing, providers must interpret their findings, create a report, and send a report to the ordering provider as well as to others who impact the patient’s care and to whom the patient requests.
- New code 92549, a computerized dynamic posturography sensory organization test (CDP-SOT), involves six conditions (eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway) — with motor-control test (MCT) and adaptation test (ADT). In addition to testing, providers must interpret their findings, create a report, and send the report to the ordering provider as well as to others who impact the patient’s care.
Greater Push For Electronic Records
Though not a part of the formal 2020 announcements, electronic health care records — versus paper documentation — are becoming the standard, making it important that audiologists embrace them sooner rather than later. It’s expected they will be mandatory at some point.
A couple of legislative developments also provide a timely opportunity for proactivity. Consider supporting H.R.4056 and S.2446, which would:
- Allow recognition of audiologists as practitioners
- Eliminate the prerequisite of a physician’s order to seek audiologic care
- Allow reimbursement for all services audiologists provide — rather than just diagnostics — including rehabilitation, tinnitus treatment, vestibular care, and more
Are you confidently navigating billing, coding, and third-party payers? Each has a potentially critical role in the efficiency and success of your business. Count on Audigy, which has the business experts, data-driven platforms, and vital tools to help you thrive today, tomorrow, and beyond. Contact us to to learn more about our billing and coding services.