Interview with Michael Knittel Reimbursement Director, Symphonix

AO/Beck: Hi Michael, thanks for spending a little time with us this morning.

Knittel: Hi Doug, nice to meet you.

AO/Beck: Michael, I know you've been involved with reimbursement issues for quite a while. Can you please give me a brief sketch of your background?

Knittel: Sure Doug, I have over 15 years experience in the medical industry, and bring to Symphonix a solid understanding of reimbursement and the issues surrounding health care. Before coming on board, I was the billing manager for MedAmerica Office Billing Services, where I was responsible for overseeing all accounts receivable functions, including billing procedures and coding, for more than 14 ambulatory care centers. Before that, I served as a reimbursement supervisor at Biex, Inc. in Dublin, CA and Advanced Infusion Systems, Mountain View CA. I have held related positions at Good Samaritan Health Care Systems, San Jose CA, Wound Care Center at Morristown Memorial Hospital, Morristown New Jersey, and MadeToOrder.com, Oakland CA.

AO/Beck: Thanks Michael. OK, moving to middle ear implants and the billing and coding issues related to them, where are we? Can we bill third parties, and perhaps more importantly, if we do bill them, will we get paid?

Knittel: Doug, I have lots of good news on this. Symphonix is breaking the ground in this arena. We are successfully getting pre-approval for many middle ear implants, not all, but many. The current trend is that over 70 percent of those we apply for get pre-approval from their insurance companies. So, patients who have private insurance or those that have a secondary policy to Medicare have a good chance of obtaining reimbursement.

AO/Beck: And it seems to me like the whole name of the game here is pre-approval?

Knittel: Pre-approval is the key. We want to be certain that the otologist's office correctly and efficiently applied to the insurance company to obtain pre-approval prior to the implant procedure. That is the protocol Symphonix advocates.

AO/Beck: Just out of curiosity, what is the category that the implant is billed through?

Knittel: It is billed under prosthetic, implant.

AO/Beck: Michael, what is the typical turn around time from the application for pre-approval until we get a letter from the insurance company telling us it's a covered benefit?

Knittel: It can vary, but typically about two weeks, and it wouldn't be unusual to go out about 6 to 8 weeks.

AO/Beck: OK, that sounds about right based on what I've heard from the clinicians. Michael, please walk me through the steps from identification of an appropriate patient, to getting the pre-approval notice...what do you recommend?

Knittel: The best thing is to have the patient see the audiologist to determine candidacy. If appropriate, the audiologist refers to the otologist. The otologist does their evaluation, and if the otologist believes the patient is an appropriate candidate they write a letter to the insurance company explaining their findings and their recommendation. If possible, that's a good time for the doctor's office to call and let me go through the paperwork with the office manager to make sure it is filed correctly. As you know, it is much easier to do this right from the beginning, rather than going back and trying to correct mistakes later. Because we've done this many times, we can catch a potential problem and rectify it before it goes too far!

AO/Beck: And that is a free service that you offer?

Knittel: Yes that's correct. The professionals and the patients can call me, and Symphonix is happy to work directly with them to get the paperwork processed. I can be reached at michealK@symphonix.com or at 1-800-833-7733, extension 1745, or of course they can go to the website, www.symphonix.com and we have some information available there too.

AO/Beck: Michael, what is the number one mistake people make when trying to get these claims approved and processed?

Knittel: Probably the biggest mistake is referring to the implant as a hearing aid. It is a prosthetic implant, not a hearing aid, and that is a very significant difference! Additionally, if the otologist believes it is a medical necessity, and if they use that term in their report, that will help in the approval process too.

AO/Beck: So it seems like the trend is turning and middle ear implants are becoming more and more reimbursed via insurance plans?

Knittel: Yes that's correct. We have certainly learned how to better file and process claims, and we are of course willing and able to share that information with our professionals and our patients.

AO/Beck: Michael, any news on the CMS issues regarding Medicare and Medicaid?

Knittel: We are currently working with Medicare and are hoping for a decision by this summer.

AO/Beck: Good enough Michael. Thanks for your time and expertise on these issues.

Knittel: You're welcome Doug. Happy to help.

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