What's New in Reimbursement

Medicare Reimbursement rates and policy changes

Medicare periodically reviews its reimbursement rates and policies for Medicare-participating surgeons, hospitals, and other providers. Medicare starts the process with a Proposed Rule, explaining the changes it wants to make, followed by a period of time in which the public can make comments about these proposals or request modifications. “Rules” are extensive documents detailing every change Medicare plans to make. Here are a few recent Medicare changes or proposed changes.

On July 2, 2010 Medicare released its Proposed Rule for hospital outpatient and ASC reimbursement. In this rule, Medicare has proposed a national average increase in payment to hospitals of 4.2% for Baha^® and 7.4% for cochlear implants. This rule also proposed payment increases to ambulatory surgery centers of 5.9% for Baha and 9.1% for CIs. Public comments were accepted on this rule until August 31, 2010.

On June 25, 2010 Medicare also released its Proposed Rule for physician payment, which included proposed rates for surgeons and audiologists. Although this rule provides insight into general increases or decreases in the value in individual procedures, actual payment rates will ultimately depend on legislation from Congress expected to be voted on before the end of the year.

Proposed Rules do not become enforceable until they are published as Final Rules. Various Medicare and other listservs offer sevices to keep you posted on newly introduced proposed rules and on the issuance of Final Rules. These are useful means to try to stay aware of these types of changes.

Cochlear Americas’ Reimbursement Managers also try to stay aware of the various rule changes affecting Medicare, and can be a resource for you as well. However, the Cochlear Americas Reimbursement team does not provide legal advice. Please seek your own legal advice regarding the interpretation or application of any rules to your provider / health care professional circumstances.

New Softband HCPCS Code Gaining Payer Acceptance

On January 1, 2010, a new code for Baha^® Softband was activated in the HCPCS code set.  This new code is L8692, Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment, is used to report both the Baha sound processor and the Softband itself.  In the months since this new code was introduced, many commercial insurance plans have updated their Baha coverage policies to include the new code.  However, most state Medicaid programs usually take longer to implement new codes in their billing system.

When working with a Baha Softband candidate, Cochlear Americas recommends communicating with their insurance payer to verify acceptance and coverage of new code L8692 prior to providing service.  If an insurance plan does not have the code in their system yet, any participating provider can submit a request to a payer to add a code into their system.  Although Cochlear Americas submitted information related to new codes and prices to hundreds of insurance plans at the start of this year, many times these requests are given greater priority when submitted by a healthcare provider.  For help with what type of information to submit with a request for acceptance of the new Softband code, contact your local Cochlear Americas reimbursement representative.