Acute hearing loss:<\/strong> A disabled 16-year-old patient fell out of their wheelchair and hit their head; they\u2019ve had issues hearing ever since. The audiologist should refer the patient to a physician for diagnosis. After seeing the physician, the patient may return to the audiologist for a hearing assessment. The AB Modifier cannot be used because there\u2019s acute hearing loss. <\/li>\n<\/ul>\n\n\n\nWhat Happens if You Get a Denial?<\/h2>\n\n\n\n
There are many reasons why a claim might be denied. Because it\u2019s difficult to know whether the patient was billed using the AB Modifier within the last 12 months, practices have had claims denied unexpectedly. We recommend having patients sign an ABN form prior to service.<\/p>\n\n\n\n
Many practices receive claim denials after noticing a pattern of misuse. We heard of one practice that was billing Medicare for audiograms using the AB modifier, but the driving force behind the exam was to see if the patient\u2019s hearing aid needed to be updated. Since the AB Modifier cannot be used for the purpose of prescribing, fitting or changing hearing aids, the practice was billing Medicare incorrectly.<\/p>\n\n\n\n
What happens if a practice doesn\u2019t understand how to use the AB modifier and gets claim denials? If CMS notices a problem, it may conduct a post-payment audit. They\u2019ll look at the documentation accompanying the claim to ensure it meets their criteria. If the practice makes an error, CMS will ask for a return payment if it has already paid the claim. If this persists, CMS might order a forensic audit, which means they\u2019ll look for larger patterns of misuse. The practice may have to pay back a significant amount of money if it\u2019s determined there were multiple coding errors.<\/p>\n\n\n\n
It\u2019s All in the Documentation<\/h2>\n\n\n\n
When CMS performs an audit, either post-payment or forensic, most practices get into trouble with their documentation. If the doctor adds generic notes to patients\u2019 records and they\u2019re all lined up during an audit, this becomes the doctor\u2019s standard of care. This would cause an audit to fail because patient documentation should have unique verbiage; no two patients are the same, so their notes should not be the same.<\/p>\n\n\n\n
For example, a doctor may repeatedly say that patients \u201ctolerated the procedure well.\u201d Given that doctors see 20\u201330 patients a day, there\u2019s likely someone who didn\u2019t tolerate the procedure well. Another example is when the doctor writes, \u201cProcedure also done on the contralateral side.\u201d Not all ears are the same; one ear canal may be more curved than the other.<\/p>\n\n\n\n
Careful documentation is one way to illustrate that the doctor did indeed see the patient. If a patient complains to CMS that they only saw the doctor for five minutes and there are multiple procedures listed in the bill, generic documentation can cast a light of distrust on the case.<\/p>\n\n\n\n
Next Steps<\/h2>\n\n\n\n
Issues with billing and coding are common, but they don\u2019t have to be. Michelle Netoskie, Fuel Medical\u2019s Billing, Coding & Compliance Manager, can help you through any problems that you\u2019ve encountered. Reach out to your regional manager today to schedule a billing and coding consultation.<\/p>\n\n\n\n
References<\/strong><\/p>\n\n\n\n\n- American Academy of Professional Coders. (Feb. 3, 2023). \u201cDon\u2019t assume the codes you\u2019ve been using to report drugs and biologicals still apply.\u201d https:\/\/www.aapc.com\/blog\/87268-check-out-all-the-new-codes-for-reporting-services-and-supplies-to-medicare\/<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Many ENT and audiology practices across the nation struggle with billing and coding. Coding for a range of services requires an in-depth understanding of hearing health care procedures, knowledge of up-to-date coding guidelines and insurance regulations, the ability to recognize which bundled services are included in certain codes and the time to provide accurate documentation…<\/p>\n","protected":false},"author":1,"featured_media":13080,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","header_content":"","schema":"","fname":"","lname":"","credentials":"","position":"","tenure":"","department":"","location":"","apply_url":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":"","footnotes":""},"categories":[118],"tags":[],"article_type":[12],"_links":{"self":[{"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/posts\/13072"}],"collection":[{"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/comments?post=13072"}],"version-history":[{"count":4,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/posts\/13072\/revisions"}],"predecessor-version":[{"id":13101,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/posts\/13072\/revisions\/13101"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/media\/13080"}],"wp:attachment":[{"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/media?parent=13072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/categories?post=13072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/tags?post=13072"},{"taxonomy":"article_type","embeddable":true,"href":"https:\/\/fuelmedical.com\/wp-json\/wp\/v2\/article_type?post=13072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}