COCHLEAR IMPLANTS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Disability Rights
|
|
|
|
|
|
|
Sitemap
|
|
|
|
|
|
|
This page is being rebuilt.
OTOLOGIC REIMBURSEMENT MANAGEMENT
Billing and Consulting Services for Cochlear Implants and Assistive Devices
CONTACT:
PO Box 22723
Denver, CO 80222
(303)-726-3052
reimburse@cochlearimplant.org--FOR IMMEDIATE RELEASE--
MEDICARE ALLOWS AUDIOLOGISTS TO BILL DIRECTLY FOR
COCHLEAR IMPLANT SPEECH PROCESSOR PROGRAMMING
Hobratschk's Efforts on Behalf of ASHA Avert Massive Claims Denials Nationwide
Denver, CO (January 15, 2003)--In a major victory for audiologists and cochlear implant users covered by Medicare, the Centers for Medicare and Medicaid Services (CMS) have established new procedure codes for programming of the cochlear implant speech processor.
Effective March 1, 2003, Medicare will finally recognize programming as a diagnostic instead of rehabilitative service. The change will allow qualified audiologists to bill and receive payment directly from Medicare, as they can do for all diagnostic services.
Audiologists must bill under the following new CPT codes adopted for all payers (including Medicaid and private plans) by the American Medical Association (AMA):
92601 Cochlear implant follow-up exam (under age 7)
92602 Reprogramming of cochlear implant (under age 7)
92603 Cochlear implant follow-up exam (age 7 or more)
92604 Reprogramming of cochlear implant (age 7 or more)
Medicare will only reimburse audiologists directly for these codes when performed in the non-facility setting (i.e. not a hospital or skilled nursing facility.) Payment under the 2003 Medicare physician fee schedule is as follows:
92601 $123.15
92602 $86.48
92603 $83.02
92604 $56.73
Aural rehabilitation following cochlear implantation (the speech therapy component) will move back to the generic CPT code 92507 for aural rehabilitation, as it was prior to 1996. Payment under the 2003 Medicare physician fee schedule is $72.64 if performed in a non-facility setting, or $26.98 if performed in a facility setting (i.e. hospital, skilled nursing facility.)
CPT code 92510 will no longer be in use. This code combined both programming and aural rehabilitation. Mark Hobratschk worked with the American Speech-Language-Hearing Association (ASHA) in developing this code back in 1995, while directing the reimbursement department for Cochlear Corporation. Click here for more information on Medicare payment for programming.
Previously, audiologists could not directly bill Medicare unless they were employed by a physician or physician's group, and a physician was on the premises supervising the procedure. Since physicians are not trained or qualified to perform programming, this was rarely the case. Medicare's policy caused major disruptions in care for some patients, who were forced to either pay up to $300 per visit out-of-pocket (for about 12-20 visits in the first year after surgery), or travel great distances to find a center with physicians on-site.
Medicare carriers traditionally did not enforce this physician supervision requirement. However, in 1999 Empire Blue Cross and Blue Shield of New York (the Part B carrier for New York City) began denying all programming claims billed by independent audiologists (without physicians on the premises). This resulted in mass denials for cochlear implant users in the region, many of whom received little if any explanation from Medicare for the cause.
Cochlear implant users from Beth Israel Medical Center and the New York University School of Medicine alerted ORM's founder Mark Hobratschk, who had just joined the American Speech-Language-Hearing Association. These individuals knew Mr. Hobratschk from his work with Cochlear Corporation and voluntary assistance he provided on cochlear implant Internet forums.
Mr. Hobratschk reviewed their claims and informed the centers of the problem. He then contacted several cochlear implant centers and quickly learned that the mass denials of programming claims were spreading across the country to other Medicare carriers. Within several weeks, he was meeting with CMS officials urging new codes for programming and the removal of the physician supervision requirement, as its enforcement would only hinder access to programming services for many patients. When CMS agreed to do so if AMA created new codes, Mr. Hobratschk successfully persudaded ASHA board members in May 2001 to submit a petition to the AMA.
Mr. Hobratschk also obtained letters from several prominent cochlear implant surgeons documenting that cochlear implant programming is a service performed exclusively by audiologists, for which physician supervision was entirely inappropriate. Copies of these letters will shortly be posted on www.cochlearimplant.org.
Hobratschk's landmark efforts succeeded despite the industry controversy over his relationship with ASHA. On April 25, 2000, an individual with a financial relationship to Cochlear contacted ASHA demanding they no longer employ him because of efforts of he and ORM co-founder Kevin Gaudette to curb anti-competitive and fraudulent practices in which Cochlear engaged. See the Fraud and Abuse section of the ORM website.
"This issue demonstrates exactly why my presence at ASHA was so valuable to audiologists and patients," points out Mr. Hobratschk, the most experienced person in the industry in cochlear implant reimbursement issues. "Cochlear can say whatever they want, the fact remains if I am not at ASHA, neither they, Cochlear, or most audiologists would have known about the mass programming denials until it spread nationwide, nor would they have recognized how to fix it." Mr. Hobratschk notes that it was his relationship with cochlear implant users and centers that avoided an "absolute nightmare for audiologists and patients."
"Much of the credit goes to those three CI users," said Mr. Hobratschk. "They kept after Medicare and their centers for months. In fact, one patient even won a hearing, getting a Medicare Administrative Law Judge to rule that programming was a diagnostic service." Click here for a copy of that October 2001 ruling.
Mr. Hobratschk also made sure to recognize Joanne Syrja, the Director of Reimbursement for Advanced Bionics. When Cochlear refused to help ASHA in this effort, Ms. Syrja jumped right in, and even donated a copy of AB's Device Fitting Manual, describing the programming software and instructions the company issues to audiologists. It helped convince CMS that programming was diagnostic, and clearly distinct from speech therapy. "Joanne is sorely missed," remarked Hobratschk of her retirement two years ago. "She was a person who cared about patients more than politics, and there aren't many of those in this industry."
NOTE: After the retirement of Cochlear Corporation President and CEO Ronald E. West in summer 2001, the company did finally allow employees to work with Mr. Hobratschk, and John McClanahan, Cochlear's Director of Reimbursement graciously offered to help. Even though it came at a late stage in this process, Mr. Hobratschk thanks him for the assistance he provided.
|
|
|
