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presentation

Otolaryngology Billing- Meeting Current Medicare Requirements

October 26, 2016



The Effect of Changes in Medicare Reimbursement on Podiatry

It has been quite some time since the update saying audiologists who treat Medicare patients need to make use of their own National Provider Identifier (NPI) for claims they submit to the Centers for Medicare and Medicaid Services (CMS). Note that no audiologist can perform services under the guidance or supervision of an otolaryngologist using his or her NPI for billing purposes. Hence it is important that ENT billing services make sure before processing requests for reimbursements, lest they are denied.

It's not just that, apart from obtaining their own NPIs audiologists who treat Medicare patients need to enroll with Medicare as service providers. ENT billing companies should insist that they need to get their own NPIs and a full certification certifying them as Medicare service providers, and only then will Medicare consider making payment for all their claims.

Physicians and practices have been religiously trying to comply with this update, which plays an important role in ENT revenue management, though the update is quite a few years old now. They have also been incorporating changes issued in the transmittals by Centers for Medicare and Medicaid Services. There are several complex changes that need to be updated regarding how Medicare patients are rendered treatment, and subsequently processed by ENT billing and coding companies before being finally billed.

There have been significant limitations prescribed as far as use of technicians goes, and physicians can no longer use automated computerized learning testing (otograms). As far as obtaining an NPI fresh and enrolling in Medicare for certification and getting their payments for claims faster is concerned, it is quite an easy task. Physicians and practices need to visit the government website to fill and submit their applications online. However, enrollment as a Medicare provider is a bit more complex where audiologists need to look up billing Section 2 of the 8551 form, which has to be completed as per the practice location where an audiologist is rendering services to Medicare patients, as well as Section 4 of the 855R which needs to be filled up for the practices as well as employers with whom the audiologists contracts. This helps ENT billing companies with the correct identification of where Medicare should send the payment for services rendered.

While obtaining an NPI is quite a simple exercise and may not take too long, obtaining a Medicare number can drag on for months together. ENT billing & coding companies should note that payments cannot be received unless both are complied with. Even armed with an NPI, an audiologist may have to go on without a Medicare number for months on end. As long as the Medicare number is obtained, the audiologist has to hold onto the claims for filing the services until the number is obtained.

Another issue pertains to the limit placed on the number of technicians that can be used while performing audiology services. The regulation stipulates that otolaryngologists need to be actively present during any test conducted by a technician. ENT billing services should know that unless the otolaryngologists are present during such tests, reimbursement will be denied. The audiologist's presence in the room along with the technician during the test has to be established beyond doubt. This modification stipulating the presence of an audiologist along with a technician has left ENT billing & coding companies very worried. Given the general shortage of audiologists, especially in the smaller towns, access to quality services may be restricted. An audiologist may very well be seeing another patient instead of spending time just being present along with a technician, what with limited hours at their disposal in the day. However, CMS is also permitting Medicare Part B contractors, and practices are at liberty to contract with such contractors, making the interpretation of this modification a bit easier. It would do well for ENT billing services, physicians and practices to get in touch with their Medicare contractors to know more about how they would interpret these modifications.

 

Category : Outsource Medical Billing