Alternative Revenue Streams and the Billing & Coding Process By KIM CAVITT, Au.D.

Author: Kim Cavitt, Au.D.

The hearing healthcare industry is in the midst of a great deal of change. Many audiology practices, which built sustainable business models on hearing sales, are seeing these revenues at risk. More and more patients now have access to insurance coverage or discount programs managed by third-party administrators. This results in reduced revenues for audiologists and their practices. It is important that audiologists begin to explore modifications in their pricing model, expansion of their clinical offerings and alternate revenue streams.

Kochkin et al 2010 discussed a “common sense” evidence-based process for fitting hearing aids. Inclusion of these services not only constitutes best practices but also offers an excellent opportunity for increased revenue. Here are some of the most commonly omitted procedures and their accompanying codes:

  • Hearing aid evaluation (92590/1 or V5010): According to a recent AAA survey, 67% of audiology practices currently bundle their hearing aid and hearing aid services under a single price point and code. Audiologists need to realize that they do not capture payment for their hearing aid evaluation appointment and procedures if they do not bill and collect payment separately for the hearing aid evaluation, especially in cases where the patient does not proceed with amplification. While Medicare does not reimburse these codes, as they are associated with a hearing aid, many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures.
  • Evaluation of Aural Rehabilitation Status (92626/7): These codes do allow you to capture reimbursement, from the patient or the payer, for completion of procedures such as the Hearing Handicap Inventories, COSI, APHAB, QuickSIN, HINT, etc. These procedures could be completed and billed both pre and post fitting. While Medicare does not reimburse these codes if associated with a hearing aid (although these codes would be covered by Medicare if associated with a cochlear or auditory osseointegrated implant), many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures.
  • Electroacoustic analysis (92594/5): These codes allow you to capture reimbursement from the patient or the payer for completing an electroacoustic analysis of the hearing aid (either prior to fitting or on unbundled, for out of warranty hearing aid cases, or for cases where the hearing aid was purchased elsewhere) in a hearing aid analyzer (such as a Fonix test box). While Medicare does not reimburse these codes, as they are associated with a hearing aid, many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures
  • Conformity Evaluation (V5020): This code allows you to capture reimbursement for real-ear measurement and/or functional gain testing. These codes can be used for both new hearing aid fittings, for follow-up verification if not bundled into the cost, or for patients who procured their hearing aid from another provider. While Medicare does not reimburse these codes, as they are associated with a hearing aid, many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures.
  • Hearing Aid Programming/Reprogramming (V5014): This code means “repair/modification of hearing aid”. This code can be used to capture revenue for programming a hearing aid. These codes can be used for both new hearing aid fittings, for re-programming if not bundled into the cost, or for patients who procured their hearing aid from another provider. While Medicare does not reimburse these codes, as they are associated with a hearing aid, many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures.
  • Aural Rehabilitation (92630/3): 92630 is for aural rehabilitation on the pre-lingually hearing-impaired and 92633 is for aural rehabilitation on the post-lingually hearing impaired. These codes can be used to bill for counseling, speech reading, auditory training, LACE, and aural rehabilitation. While Medicare does not reimburse these codes if associated with a hearing aid, many third-party payers recognize these codes and pay separately for the associated procedures. It is also important to note that patients may be billed privately for provision of these procedures.
It is also important to mention two very important procedures and services that are commonplace (but not often addressed) in audiology practices.

  • Tinnitus assessment (92625): This code represents the procedures involved in a basic tinnitus assessment. This must include, but is not limited to, pitch, loudness matching, and masking. Medicare covers this procedure if performed by a licensed audiologist or physician, if it is medically necessary and a physician order is present. Many other third-party insurers also recognize and cover this code.
  • Tinnitus Management (92630/3 or 92700): These codes can represent the time and procedures involved in the tinnitus management/rehabilitation/training process. Many private insurers, including Medicare, do not pay for tinnitus management. As a result, the patient is financially responsible for the services.
It is always important that audiologists read their third-party agreements in their entirety and ensure that it includes a current fee schedule. This fee schedule should include codes for all of the items and services your practice provides. These contracts dictate your rights and responsibilities as a participating provider in their plan. Contractual agreements often dictate that if you charge their entity for a given item or service that you charge your general population for that same item or service. In other words, you cannot bill something to a third-party payer that you are giving to others, specifically private pay patients for free. So, sometimes you are going to have to have patients pay privately when their insurer does not cover the item or service. This private payment is becoming increasingly more important as third-party reimbursement decreases and managed care involvement in the hearing aid process increases.
References
Kochkin S. et al (2010) MarkeTrak VIII: The Impact of the Hearing Healthcare Professional on Hearing Aid User Success. Hearing Review, 17, 4. Downloaded at http://www.betterhearing.org/pdfs/M8_Hearing_aid_user_success_audiologists.pdf).

Kim Cavitt, Au.D. was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the Board of the Academy of Doctors of Audiology and the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.