Adult home-based hearing therapy manuals for you and your patients

Life gets simplified with the online Cochlear Store. Through this easy-to-use online portal, your patients will find the accompanying parts and accessories they need to get the most out of their sound processor. Depending on their specific health plan, patients may even have the option to utilize direct insurance billing for medically necessary parts and accessories.

Patients can easily shop for products they need to enhance their hearing experience – whether it’s a new rechargeable battery, replacement microphone covers or Cochlear True Wireless™ accessories. With personalized shopping based on their personal device and insurance resources, the Cochlear online store is the most convenient way for patients to customize their hearing experience with the latest accessories.

Beyond the convenience of online shopping, patients are also eligible for free shipping on orders over $50*. The online store denotes parts and accessories that are commonly covered by insurance using this icon, and when ordering these items, Cochlear’s Reimbursement & Insurance Services may be utilized to bill their applicable private insurance plans, Medicare and many state Medicaid plans.**

Other features of the online Cochlear Store include:

1. Quick and simple navigation to and from your patient’s Cochlear Family account
2. A refined product catalog with easier navigation features
3. A customized shopping experience for your patient based on their device
4. Access to exclusive promotions

The Cochlear Store is available to all Cochlear Family members. Registration for Cochlear Family is free, fast and incredibly simple – patients can start by visiting Cochlear Family.

*Select one of the following shipping methods during checkout:

(1) 5 – 7 business days (Ground) FREE

(2) 3 – 5 business days (Ground) FREE

Free shipping is valid on orders over $50 and shipped to single U.S address after promotions and discounts are applied.

Taxes do not qualify toward the minimum purchase requirement.

Offer and delivery times are subject to change without notice and exclude purchases from Cochlear Americas.

**As of Feb 1, 2018, Cochlear provides direct insurance billing support for many major private insurance plans, Medicare, Medicaid† (including HMOs) and Tricare for repairs, parts and accessories. Cochlear’s full-service billing support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. If a recipient would like to place an order for a replacement part or accessory, please keep in mind orders may take up to 2 weeks to process and ship, so please plan ahead.

†Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, DC, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY.

Information for patients:

Please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim on your own if Cochlear is contracted with your private insurance provider. Visit www.Cochlear.com/US/InsuranceList to see if Cochlear is contracted with your insurance provider. If Cochlear is contracted with your insurance provider, we suggest placing your order through Cochlear’s Reimbursement and Insurance Services. If you seek reimbursement on your own you will be solely responsible for any amounts to include contractual or discounted payments that your insurance provider does not cover.

Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record. You will be responsible for paying any applicable coinsurance, deductible, or amounts not covered by your insurance to Cochlear. Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.

By guest author: Keith Latiolais, MBA, MHA

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released their annual changes to the Medicare Physician Fee Schedule (PFS) and other Medicare Part B payment policies. Proposed rule CMS–1693–P includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. The rule was published on July 27, 2018 and is available for public comments through September 10, 2018.

CMS proposed increasing Physician Fee Schedule (PFS) payment rates by 0.25 percent in 2019, as required by the Medicare Access and CHIP Reauthorization Act. After applying the budget-neutrality adjustment which is required by law, CMS estimates the 2019 physician fee schedule conversion factor to increase from $35.99 this year to $36.05 in 2019. CMS included a number of other provisions in the rule including revaluation of outdated E/M code set to address complexity of documentation requirements, distinguish differences among code levels and sites of service, update for changes in technology, especially electronic health record (EHR) use, and physician pay for virtual and telephone visits.  Details are available on the CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-P.html  see section I. Evaluation & Management (E/M) Visits.

CMS is proposing implementation of these rules beginning January 1, 2019, but is sensitive to stakeholder comments and as such may consider a delayed implementation which also might allow the AMA time to develop changes to the CPT coding definitions and guidance prior to implementation.  To be assured consideration, comments must be received no later than 5 p.m. on September 10, 2018.  In commenting, please refer to file code CMS-1693-P.  Electronically, commenters may submit to http:www.regulations.gov or by regular mail to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1693-P, P.O. Box 8016, Baltimore, MD 21244-8016.

The following is a summary of the impact of the proposed changes specific to professional services related to cochlear implants and auditory osseointegrated implants. The tables below illustrate the difference between the geographically unadjusted participating surgeon and audiologist rates for the current year and those which have been proposed for CY 2019. The last table includes the Medicare allowable rates for facility based audiologist.

Note:  Physician payment for services performed in the facility setting (as well as in the office) is calculated using national uniform relative value units (RVUs) that account for relative resources used in furnishing a service.  The statute requires that RVUs be established for three categories of resources: Work, Practice Expense (PE), and Malpractice (MP).  Beginning in CY2010 with final implementation in CY2013 CMS began using the AMA Physician Practice Expense Information Survey (PPIS) to establish a methodology for Practice Expense RVU calculations.  Analysis of 2019 CI implantation codes indicates a reduction in overall RVU, hence reimbursement, primarily due to a re-evaluation of Practice Expense RVU methodology.

Payments are based on the relative resources typically used to furnish the service. Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute. 

About our guest author:

Keith Latiolais is one of three geographically-based hearing implant reimbursement experts available to assist you with coding, payment, payer coverage, contracting, and other reimbursement-related challenges. Keith’s contact information, along with that of his colleagues and a more detailed description of the reimbursement support offered by Cochlear’s Regional Reimbursement team, can be found on the Reimbursement Support page of Cochlear’s US Professional Resources Website. Please do not hesitate to reach out to the Reimbursement Manager associated with your geography for reimbursement assistance or for questions related to this article. Cochlear offers coding assistance through the Coding Support Line accessible by calling 1-800-587-6910 between the hours of 8 AM – 3 PM Mountain time zone or via email at codingsupport@cochlear.com. For pre-surgical insurance support, OMS is available to assist with pre-authorizations and appeals and can be reached at 1-800-633-4667 option 4.

References:

1. Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019,  Retrieved from:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.html   August 2, 2019

Health economics and reimbursement information provided by Cochlear Americas is gathered from CMS and other third-party sources. The information is subject to change without notice as a result of changes to laws, regulations, rules and administrative policies. CPT and CPT material are copyrights of American Medical Association (AMA): CPT copyright 2018 American Medical Association, all rights reserved. CPT is a registered trademark of the American Medical Association. The information provided in this document is provided as guidelines only to address the unique nature of implantable hearing solutions technology. This information does not constitute reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding this information or its completeness, accuracy, fitness for any purpose, timeliness, or that following these guidelines will result in any form of coverage or reimbursement from any insurance company or federal health care program payer. The information presented herein is subject to change at any time. This information cannot and does not contemplate all situations that a health care professional may encounter. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement and coding needs and the proper implementation of these guidelines. All products should be used according to their labeling. In all cases, services billed must be medically necessary, actually performed, and appropriately documented in the medical record.