As Audiology transitions to a doctoring profession, one point has never been more clear: the success (or failure) of an audiology practice will depend largely on the audiologist's awareness and understanding of billing, coding, reimbursement and compliance.
There is a difference between coverage and reimbursement. Coverage, in health care, is when a third-party is paying, in whole or in part, for the items and services provided. Coverage is a part of reimbursement. Reimbursement is when the audiologist or practice receives payment for services rendered. Sometimes that payment comes in the form of coverage from a third-party payer. While others times the payment comes directly from the patient themselves. As a result, not all reimbursement does or should come from a third-party payer.
Reimbursement is what brings revenue to a business, pays the operating expenses and pays for salaries. Even a busy practice employing state-of-the-art methods and products will suffer if it maintains antiquated office management and billing systems. A strong grasp of reimbursement issues and application of modern office management processes is necessary to run a profitable business. But profit is not the only benefit; a well-managed business creates a lasting impression of professionalism.
Health insurance is an integral component of American life; therefore, it is incumbent upon Audiologists to be active, knowledgeable and savvy participants in the managed care arena if they want to be part of a viable, autonomous health profession.
This reimbursement section is designed to offer tools and resources to help busy practitioners stay on top of this ever-evolving reimbursement arena.
- Physician Quality Reporting System (PQRS)
- Important Considerations for Audiologists When Reviewing Third-Party Payer Provider Contracts
- Coding Reference Charts: for CPT, HCPCS and ICD10.
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.