While we were campanology in the new year, several important coding and agreement changes for audition bloom affliction took effect. There are new and revised otoacoustic discharge (OAE) codes, an added admeasurement for the Physician Quality Advertisement Arrangement (PQRS), changes to the Bloom Insurance Portability and Accountability Act (HIPAA), a new Advanced Beneficiary Notice form, and changes in Medicare enrollment.
Before they adjourned at the end of 2011, Congress accustomed a two-month extension, which abeyant the planned agreement cuts that on Jan. 1 would accept cut all Medicare-reimbursed procedures by 27.4 percent. This addendum will acquiesce 2011 ante to Medicare beneficiaries to abide until the end of February, giving Congress time to accede on a long-term, abiding band-aid to the Sustainable Growth Rate, a awry arrangement that threatens to access the cuts to agreement anniversary year. If Congress fails to act by the end of February, the 27.4 percent abatement for all Medicare reimbursed procedures will booty effect. This fee agenda is not alone capital to Medicare agreement rates; abounding bartering payors additionally abject their fee schedules on the Medicare fee schedule.
Audiologists accept suffered several alternating years of abysmal decreases in reimbursement, abnormally for bulk procedures such as CPT cipher 92557 (comprehensive audiometry and the arranged immittance assay codes), 92550 (tympanometry, acoustic reflex thresholds), and 92570 (tympanometry, acoustic reflex thresholds, and acoustic reflex decay). The abatement in agreement for 92557 and several added audiology procedures is a aftereffect of the alteration in agreement status.
Audiologists confused from the non-physician adjustment of acquittal to actuality accustomed and paid for assignment and cognition, one of the three apparatus of the about bulk assemblage blueprint (the added two are convenance bulk and able liability).
CPT codes are created by the American Medical Association About Bulk Scale Committee and again submitted to the Centers for Medicare and Medicaid Casework for approval. CMS decreased the OAE agreement levels for CPT codes 92587 and 92588 from the recommended ethics in the 2012 final aphorism for the Medicare Physician Fee Schedule.
The abatement in agreement for the 2010 arranged codes 92540 (basic vestibular evaluation), 92550, and 92570 is a aftereffect of a awning conducted by CMS on all procedures performed 90 percent of the time or added on the aforementioned date of service. These articular casework were again appropriate to be arranged into one cipher as a Medicare cost-saving measure. Since that time, audiologists accept accomplished a 50 percent abridgement back a affirmation is filed with 92540. It is advancing that added activity codes will be confused to a arranged architecture through this activity in the future.
CMS additionally advance codes that accept a abundant access in appliance over a abbreviate aeon of time. This abnormality occurred with the bound OAE code, 92587, which bent CMS’ attention. An aboriginal assay of audiologists illustrated two uses for 92587, screening and limited, and as a result, a new screening OAE CPT code, CPT 92558, after-effects in a pass-fail acknowledgment via automatic analysis. The definitions and requirements for CPT codes 92587 and 92588 accept been clarified, and a abode answer the assay after-effects charge be included in the blueprint notes.
CPT cipher 92558 covers evoked otoacoustic emissions, screening (qualitative altitude of baloney artefact or brief evoked otoacoustic emissions), and automatic analysis. This cipher is a pass-fail screening at a distinct acuteness akin with automation. This is not a covered account beneath Medicare, but you will charge to assay with your bartering payors for advice on this code.
CPT cipher 92587 is baloney artefact evoked otoacoustic emissions; bound appraisal to affirm the attendance or absence of audition disorder, three to six frequencies, or brief evoked otoacoustic emissions with estimation and report. This cipher is acclimated back you are testing three to six frequencies bilaterally for baloney artefact OAEs. If you additionally accomplish brief OAEs, your payor may admit the -22 modifier added procedural services. CPT cipher 92587 includes the estimation of the assay and a abode of the after-effects in the patient’s record. You will charge to assay with your Medicare contractors and bartering payors for advice on this cipher and associated modifiers.
CPT cipher 92587 will accept a assignment bulk of 0.35 (from the recommended 0.45) for a agreement bulk of about $28 to abode the SGR. This bulk does not accommodate the Geographic Price Cost Index. You will appetite to assay your Medicare contractor’s website for the best accepted fee schedule.
CPT cipher 92588 covers absolute analytic appraisal (quantitative assay of alien beard corpuscle activity by circling mapping) with estimation and report. It requires a minimum of 12 frequencies in anniversary ear, with the estimation of the assay and a abode of the after-effects in the patient’s record. If beneath than 12 frequencies were performed, you will book the affirmation with 92587. Again, assay with your Medicare contractors and bartering payors for advice on this cipher and associated modifiers.
CPT cipher 92588 will accept a assignment bulk of 0.55 (from the recommended 0.60), for a agreement bulk of about $43. This does not accommodate the Geographic Price Cost Index. You will appetite to assay your Medicare contractor’s website for the best accepted fee schedule.
For audiologists who convenance in hospital outpatient facilities, there will be a slight access to the 2012 Outpatient Prospective Acquittal Arrangement (OPPS) ante with the barring of basal absolute audiometry, circling implantation, and evoked otoacoustic discharge testing. The ambulant acquittal classifications accept been afflicted for 92570, consistent in an increase, but the end aftereffect will be a abatement because of a reclassification of CPT cipher 92588. While the ante for commodity of osseo-integrated accessories will access slightly, the acquittal for circling commodity and implant aftereffect will decrease.
No ICD-9 or HCPCS codes pertinent to audiologists were added for 2012. The date of acquiescence for the ICD-10 codes will be Oct. 1, 2013, and practices will charge to adapt their appointment forms and computer systems and argue with announcement and clearinghouse vendors to ensure compliance. (See FastLinks for added added advice on the ICD-10 about-face process.)
CMS has added an added admeasurement in 2012 on which enrolled Medicare Part B audiologists may report. The Referral for Otology Appraisal for Patients with Acute or Chronic Dizziness admeasurement brings the absolute acceptable reportable measures for audiologists to four, forth with complete or alarming aberration of the ear; a history of alive arising from the ear aural the antecedent 90 canicule (for patients who accept ache of the ear and mastoid processes), and abrupt or rapidly accelerating audition loss.
Audiologists are encouraged to abode on all four measures to access able acceptance aural Medicare as able-bodied as defended a 0.5 percent benefit of all acceptable accuse until 2014 for acknowledged reporting. Beginning in 2015, providers who do not abundantly abode on acceptable measures will face a 1.5 percent amends on Medicare reimbursement. Participating in Physician Quality Advertisement Arrangement is easy. Just add a modifier to the CMS-approved CPT and ICD-9 codes. (See FastLinks for added information.)
Effective Jan. 1, the Bloom Insurance Portability and Accountability Act appropriate the use of HIPAA adaptation 5010 for accessories that abode claimed bloom information, but CMS afresh appear it will not accomplish it until March 31. All announcement vendors are appropriate to use HIPAA adaptation 5010 in alertness for the Oct. 1, 2013, acquiescence of the new ICD-10 ache coding system. The antecedent HIPAA version, 4010, is accordant with the ICD-9 coding arrangement but not with ICD-10. If your affirmation vendors are not in compliance, claims will acceptable be denied.
Any ability that accesses, stores, or transmits claimed bloom advice is appropriate to accommodated HIPAA standards. The Appointment for Civil Rights and the Department of Bloom and Human Casework will abide to assay HIPAA aloofness and aegis compliance. Covered entities, including audiology practices, may accept a letter to assay analysis protocols.
Data breaches abide to accomplish account because those affecting added than 500 patients charge be appear to the bounded media. (See FastLinks for added on this from HHS.) Finally, accompaniment attorneys accepted are now accomplished to accomplish HIPAA audits, and may affair fines if breaches are discovered.
Providers enrolled in Medicare Part B above-mentioned to March 25, 2011, including audiologists, will be accepting belletrist from their Medicare architect acute the revalidation of Medicare acceptance this year. Providers charge revalidate aural 60 canicule of accepting the letter or accident accepting their Medicare Provider Transaction Number deactivated and claims denied. The letter will access in a black envelope for simple identification, and contractors accept requested that you not act until you accept it. (See FastLinks for a sample revalidation letter and added information.)
Those who enrolled in Medicare above-mentioned to 2004 will additionally charge to accept in the Provider Acceptance Chain, Ownership Arrangement (PECOS). (See FastLinks.) PECOS additionally may be acclimated to amend a change in appointment abode or a change in a final adverse activity no afterwards than 30 canicule afterwards these accept occurred.
Changes in Social Aegis numbers, business anatomy (e.g., a sole cartel to a corporation), or reassignment of allowances if the provider is not enrolled in PECOS charge be submitted via adamantine archetype no afterwards than 90 canicule afterwards the change occurred.
CMS additionally issued a new Advanced Beneficiary Notice form, CMS-R-131, which charge be activated afterwards Jan. 1. The anatomy has the “3/11”release date in the lower larboard corner. (See FastLinks for instructions on use.)
Effective aftermost March 25, alone Medicare institutional providers were appropriate to pay an acceptance fee back initially enrolling in Medicare, revalidating their Medicare enrollment, or abacus a new Medicare convenance area back filing the CMS 855A. The fee for 2012 is $525, and applies alone to institutions such as rehabilitation facilities, not clandestine convenance audiology or otolaryngology offices.
• Added advice on the ICD-10 about-face activity is accessible at http://go.cms.gov/v3uXkT, http://bit.ly/vtizHl, and http://bit.ly/urwEjw.
• Read added about the Physician Quality Advertisement Arrangement and the modifier to CMS-approved CPT and ICD-9 codes at www.cms.gov/PQRS.
• HHS has advice about abstracts breaches at http://1.usa.gov/HIPAAprivacy.
• Read added about Medicare revalidation at http://go.cms.gov/revalidations.
• For added advice about the Provider Acceptance Chain, Ownership Arrangement (PECOS), appointment http://bit.ly/PECOS.
• The new Advanced Beneficiary Notice form, CMS-R-131, and instructions for its use are accessible at http://go.cms.gov/RevisedABN.
• Comments about this article? Write to HJ at [email protected]
• Follow us on Cheep at twitter.com/hearingjournal.
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