Audiology Coding: Back to Basics

Accurate coding is key to timely reimbursements for your audiology services.

But contracts can make what seems straightforward feel like a maze. Sure, you can always correct an error — but what will the cost and delay be?

We’re taking you back to basics to make sure you can confidently navigate audiology coding to get what you’re owed when you expect it.

Be Patient Around the New Year

Medicare isn’t always ready on January 1, when new procedure codes are effective. When using new codes, be prepared for potential denials and delays until Medicare gets their system up to date.

Know Each Payer’s Fee Schedule

Familiarize yourself with the go-to codes for the specific procedures and services your practice provides, and document your coding process.

Verify the codes by phone as well, and note the reference number, to whom you spoke, and the date and time of your call.

Know Your Codes

Any third party you contract with will recognize a specific set of codes — but they might be different from the ones you’re used to.

Compare your go-to procedure, diagnosis, service, and device codes to the ones on your third-party contracts. Any differences? Make sure they’re noted and highlighted for all your coding personnel.

You should also know each payer’s payment schedule. Though you bill everyone the same, each payer won’t pay the same.

Review Your Fee Schedules Regularly

This especially applies to Medicare. If a procedure isn’t on your fee schedule, you probably won’t get paid. Make it a habit to proactively check for any new procedure codes.

Check your Medicare contractors for local coverage determination policies, as well. These drive Medicare payments based on medical necessity and a physician order.

Verify, Verify, Verify

Don’t dispense a new hearing aid without verifying the patient’s benefit with the applicable third-party contract. It should be clear to you, the third party, and the patient who is responsible for each portion of what’s owed before each device leaves your office.

This might seem like overkill — but you stand to lose thousands of dollars. Get the name of the person you spoke with to verify benefits, and note the time, date, and reference number of the call.

Know What Must Be Written Off

Most third-party contracts prohibit balance billing, which looks like this: You charge $200 for a service, your contract’s allowed amount is $160, and you try to recoup that unpaid $40 by billing your patient for it.

In this example, if your contract prohibits balance billing, you’ll have to write off that unreimbursed $40.

It’s crucial for you to know the nuances. Is the prohibition across the board? Is it for diagnostic services only? What about uncovered services?

This underscores the importance of verifying benefits as well as using the insurance companies’ terminology, ensuring everyone’s on the same page.

Just Say No

Don’t be afraid to say no. If a contract doesn’t work for your practice, don’t sign it.

For some contracts, you need to know what your hourly rate is — even if you don’t charge by the hour. Some contracts pay a small flat fee and prohibit balance billing. If you know your hourly rate, you’ll be in a position to judge whether you’d even be able to remain in business for long with that contract.

Worried your patient will go to the competition? Let them. Your competition will learn soon enough that the payment is unworkable.

Our revenue-cycle management services remove the time-consuming processes that take you away from focusing on patient care and revenue-generating activities.