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Reimbursement: The 2012 Perspective

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1.  To qualify for reporting the diagnostic OAE code (92588), one must perform a minimum of 6 frequencies per ear a minimum of 6 frequencies replicated once per ear a minimum of 12 frequencies per ear a minimum of 12 frequencies replicated once per ear

2.  The screening OAE code (92558) requires an interpretation and report was developed for protocols that rely only on automated scoring must be performed by an audiologist must be used for infants in the ICU longer than 5 days

3.  MEDPAC, IOM, and CMS each advised Congress that payments should move away from "fee for service." Why? processing the claims has become too complicated with ICD-10 reimbursement continues to decrease every year there is too much Medicare fraud providers are incentivized to do more in order to be paid more

4.  Medicare has initiated Value Based Purchasing in order to focus on effectiveness of treatment require clinical and financial accountability focus on episodes of care all of the above

5.  The short term effect Value Based Purchasing will have on diagnostic procedures will be to bundle payments for grouped diagnostic procedures allow providers to earn more through increased utilization create a reimbursement system based on the cost of service delivery focus on practice expense elements of the total RVU

6.  The change to ICD-10 will involve dealing with almost 10 times the number of diagnosis codes that currently exists in ICD-9 an update of the 389.XX family of ICD-9 codes minor software upgrades for Medicare, HMOs, and insurers a large financial windfall for Blue Cross Blue Shield

7.  Along with ICD-10 we anticipate the inclusion of a link to the relative value units of CPT inclusion of functional scale measurements suitableness for rehabilitation the requirement for more team evaluations

8.  These changes in reimbursement patterns will force all health care providers into bankruptcy into group practices to make adjustments based on the cost of service delivery to see fewer patients

9.  From a CPT coding perspective, we anticipate continued bundling of various procedures into single codes an eventual increase in reimbursement to compensate for previous reductions greater Congressional pressure on the AMA to create new codes short term elimination of the code valuation process

10.  The Medical Home Project is expected to begin in 2012. It's primary goals include all but one item: the primary care physician coordinating and approving all aspects of a patient's health care better efficiency and decreases costs for patient care open access to all providers, including audiologists the opportunity for the primary care physician to get to know the patient and his/her family