checklist

Effective Reimbursement: A Checklist for Audiology Practices

Successful audiology practices use a number of procedures and protocols to stay in compliance with Federal and State laws, while keeping an eye on efficiency, simplicity and patient satisfaction. The following checklist was developed for the ADA membership to help identify areas that may improve practice management efficiency:

• Create and use a patient registration form that includes insurance information.
• Verify demographic and/or insurance information at every patient appointment.
• Photo copy (both sides) patient’s insurance cards.
• Collect co-pays, deductibles, out of pocket charges, deposits and purchase payments at the date of visit.
• Create and use a standardized Superbill for every patient encounter; it should contain all of the CPTs, ICD9s and HCPCS codes that are used on a daily basis. Superbills need to be updated each December to reflect coding changes (CPT, ICD9 or HCPCS) for the coming year. Failure to update Superbill coding could result in claims denials.
• Cross check the Superbills to the clinic schedule each day to ensure that every patient is accounted for.
• Read the Information on the Advanced Beneficiary Notice (ABN) and review the attached combined ABN/Notice of Exclusion of Medicare Benefits (NEMB) form. Use it in accordance with the outlined instructions. Patients should read and sign an ABN prior to having services rendered. Inform Medicare that you have obtained a signed ABN and add the –GA modifier to the claim next to those procedures outlined on the ABN. The new ABN allows you to collect payment at the time of the visit and to refund the patient if Medicare pays for the procedure(s) outlined on the form. When this form is used as an NEMB, always have the patient choose Option #2.

» Download Advance Beneficiary Notice and Instructions (PDF)

• Electronically submit all claims within one business day of completing the service.
• Maintain current copies of CPT, ICD9 and HCPCS manuals.
• Establish a strict claims denial process.
• Evaluate each carrier's reimbursement schedule. Base decision to participate on individual practice situation. A provider is not required to contract with carriers whose reimbursement is not adequate.
• Establish a strict hearing aid and hearing aid-related service payment policy; goods and services should be paid in full by the day of delivery.
• At a minimum, establish a non-refundable hearing aid evaluation charge and collect it on the date of a hearing aid order and/or the date of the hearing aid evaluation. [Note: Practitioners should follow state regulations under their business code practice guidelines for non-refundable fees, if any.]
• Do not offer payment plans unless they are underwritten, financed and/or administered by a separate financial company or lending institution.
• Accept credit card payments.
• Secure the services of a third-party financing company that your patients can use for hearing aid financing needs. Negotiate the percentage that the company keeps for their services. Do not provide your own direct financing.
• Establish a bad debt/unpaid balance write off policy.
• Establish a strict collection policy and use a collection agency.
• Review accounts receivable on a monthly basis.
• When contracting for hearing aids, carve hearing aid coverage from managed care contracts whenever possible so your practice is not obligated to accept their payment schedule for amplification. Specifically this means that when negotiating an insurance contract including hearing aid coverage, try to exclude the hearing aid coverage within the terms of the entire contract or create a contract portion specific to hearing aids that is more favorable to your practice.

EXAMPLE:
You have offered to accept a 30% discount off of regional usual and customary charges for diagnostic services and a patient cannot be balance billed for the difference. The carrier wishes to include hearing aid coverage as well, but you do not want to commit to that same 30% discount and balance-billing restriction for hearing aids. If the carrier insists that a hearing aid benefit remains, it would be better to propose an amendment to the contract setting up a standard dollar amount benefit solely for hearing aids and have the ability to balance bill the patient for the difference between this and your usual hearing aid fees.

• Avoid 'invoice plus hearing aid coverage' contracts; the best hearing aid coverage contracts allow for a defined maximum amount per defined time period (i.e. $1200 benefit every 36 months).
• Purchase and use office management/billing software.
• Evaluate your hearing aid-related pricing on at least an annual basis and determine if you are receiving the maximum discounts possible. If not, renegotiate with manufacturers and vendors or investigate making your purchases through a buying group. Buying groups can often provide discounting that is unavailable to smaller practices.
• Clinics need to update procedure pricing on an annual basis to reflect changes in overhead and reimbursement.

If you have any specific questions, visit the reimbursement forum or send an e-mail to the ADA Help Desk.

DISCLAIMER: The foregoing information is provided as a resource for our members. It is not intended and should not be construed as an endorsement of any of the vendors or their products or services; as such, ADA makes no warranty whatsoever, either express or implied, including the warranties of merchantability and fitness for a particular purpose regarding any of the products listed above and makes no recommendation as to the accuracy or suitability of the information for your particular situation. ADA members are encouraged to seek legal counsel to ensure compliance and are responsible for their own knowledge of both federal and state policies as it pertains to HIPAA. Neither ADA, nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including, but not limited to, any claim for costs and legal fees, arising from the use of these opinions.