The revenue that an audiology practice can make is directly tied to prompt and accurate medical billing. An audiologist must understand current coding guidelines, how to contract with third-party payers, and the latest federal and state regulations.
This article provides helpful guidelines, solutions, and relevant industry updates to audiology billing to make the process easier (and more profitable) than ever.
The Importance of Accurate, Timely Audiology Billing
Submitting accurate requests promptly is imperative if your audiology practice wants to be reimbursed for the services provided. As a general rule, you should document every pertinent detail about a patient’s visit the same day that it happened.
We highly recommend being thorough in your documentation (including test results) while limiting the use of abbreviations and jargon that can be misinterpreted or confuse the payer.
Audiology Billing Guidelines
Depending on the type of service offered by the provider or physician, there are various restrictions an audiologist must be aware of for billing and reimbursement purposes. For example, Medicare requires prior authorization from a physician before audiology services from an enrolled audiologist can be reimbursed.
Rules change, however, and it can feel like a full-time job keeping up with the latest requirements. For example, as of January 1, 2023, audiologists can perform some diagnostic testing without direct physician supervision if they use an AB modifier. There are still restrictions that an audiologist should be aware of, including the exclusion of any professional service related to a hearing aid.
The key takeaway here is that audiology billing guidelines vary by payer. You can get additional guidance on CPT code definitions from the American Medical Association. Be aware, however, that because Medicaid and private insurance companies follow different rules, there’s not a single one-size-fits-all medical coding protocol.
How to Bill for Audiology Services
Before submitting a bill for reimbursement, it’s vital to know what each payer covers. For example, Medicare classifies an audiologist as a provider of diagnostic services only, meaning this payer does not reimburse audiologists for “rehabilitation services.”
As an audiologist, it’s also crucial to know the various procedure code classifications for speech and audiology services to document for reimbursement. For example, there are different codes for speech therapy than for a hearing test, and a simple error, like transposing a number, can significantly affect revenue figures.
Knowing what qualifies as audiology services is also key to billing and getting reimbursed as a provider. The primary services under this umbrella include hearing and balance assessment, and each service or test can be performed by a qualified technician, physician, or audiologist.
For more information on billing best practices for audiology services, the book The Essential Guide to Coding in Audiology is a helpful resource. You can also attend training events hosted by Audiology Resources, Inc.
What Codes to Use
An audiologist will use three different code categories in practice management for reimbursement from Medicare and other third-party insurers.
- CPT Codes (Current Procedural Terminology: This code category denotes medical procedures, audiology services, and to bill professional component of service.
- ICD-10 Codes (International Classification of Diseases): These codes are used by a physician to code symptoms, diagnoses, and procedures.
- HCPCS Codes: This code family is for a hearing aid, accessories, and other hearing aid services.
The above codes are indicators of the services provided and the time spent with the patient in a particular area. Both the service and diagnosis, as well as the number of minutes allocated, are relevant in determining reimbursement figures.
For the most current list of code categories, you can visit official websites like CMS.gov (Centers for Medicare & Medicaid Services). This website lists important updates about CMS guidelines and physician fee schedules for audiology services.
What Documentation is Required
The key to receiving maximum reimbursement for audiology services is in the thoroughness and accuracy of your documentation. Not only is documentation critical for continuity of care, but it’s also necessary to ensure accurate billing and coding.
The documentation required for reimbursement will be any audiology services provided to the patient. The required documentation comprises two categories:
- Documentation and reasons for any test ordered
- Documentation for any skilled services provided by a qualified audiologist or technician
As a general rule, it’s a good idea to document any interactions you have with a patient, including phone calls, in-person appointments, electronic correspondence, and mail.
During the patient’s initial visit, document the reason for visiting your office, along with any relevant patient or medical history. Depending on the service or services provided, be sure to include the proper code categories.
You should also document where the audiology services took place, as documentation requirements may differ based on the treatment setting. Possible locations include:
- Your office location (if you run a private practice)
- Physician office
- University clinic
- Rehabilitation center
- Skilled nursing facility
Finally, maintain detailed patient records that include your assessments, treatment recommendations, and the rationale behind any treatments or services performed.
Tips for Getting Paid Faster
Whether the service rendered was due to medical necessity or you performed a simple test or hearing aid check, getting paid quickly and in full is critical for healthy cash flow and revenue in an audiology practice.
The right software system in your practice can streamline billing and ensure accuracy and compliance with current guidelines. For example, you can set up multiple layers of payers based on coverage so that you can quickly add them to a patient claim.
It’s also a good idea to validate your code database regularly, including CPT and diagnosis code configurations, to ensure you are billing each service appropriately.
How to Avoid Denied Claims
The best advice to avoiding a denied claim is to know whether the audiology service you performed is a covered service for the patient by the payer and whether your practice is authorized to provide the service.
For example, testing for hearing may be covered, while fitting someone for hearing aids for performing hearing aid repairs might not be. Further, it’s vital to accurately document the service you provided and use a modifier if necessary. This is particularly relevant for a hearing test. If you perform a unilateral hearing test, then use a modifier to indicate which ear underwent testing.
Note that in some instances for Medicare Part B patients, you first need a denial so that you can bill the private insurance health plan. Medicare Part B also requires an audiologist to bill services under the practice’s own NPI (National Provider Identifier), not through the NPI of a physician. Because Medicare is considered restrictive with the services eligible for coverage, an audiologist should be prepared to seek payment from other payers or the patient.
How to Follow Up on Claims and Unpaid Patient Bills
Whether you’re a physician, audiologist, technician, or speech-language pathologist, getting paid on an unpaid claim or bill can require systematic follow-up. First, have a system that tracks and monitors the status and age of patient bills. Often, this means having someone on your staff dedicated to keeping track of these items.
Make following up a priority, and don’t allow a claim or unpaid bill to continue aging. The longer you wait to collect payment, the higher the risk that the bill won’t get paid. A system like Weave can automatically follow up with your patients and collect payments via text or online. Weave can also alert your staff to aging balances.
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How to Appeal Denied Claims
The first step is for an audiologist to identify whether a claim was properly denied before investing time in an appeal. For example, confirm whether the denial is based on the service not being covered, there wasn’t prior authorization from a physician, or the established patient had exceeded the number of covered visits.
If you have thoroughly reviewed the “explanation of benefits” letter and you are confident that your practice should be reimbursed, there is an appeal process that you can follow.
The appeal process can be initiated by writing a letter describing the medical nature of the service you provided and an outline of the clinical judgment you exercised in prescribing care. The American Speech-Language-Hearing Association provides templates that can guide you in drafting the letter.
The All-in-one Audiology Billing Solution: Weave
Are you ready to maximize reimbursements and save your staff time? Weave Payments is an all-in-one solution that streamlines your billing workflow so that you can earn more money without the hassle. Weave has helped hundreds of healthcare providers collect more revenue and save dozens of hours per week. To see Weave in action, schedule a demo today.