Secret Codes
Most Audiology Codes begin with these two numbers
What are 92***
This is the specific month and day that diagnostic codes (ICD-10) are updated and changed each year.
What is October 1st?
This statement is sent by an insurance carrier to a patient explaining what medical services were paid for and what the patient may still owe.
What is an EOB (Explanation of Benefits)?
This term refers to any entity—such as an insurance company—that pays all or part of the cost of a patient's service or item.
What is a third party payer?
Items of value representing the financial resources of the practice (e.g., cash, equipment).
What are Assets?
These two-digit additions to a CPT code provide extra information about a procedure, such as indicating it was a bilateral service or a reduced service.
What is a modifier?
When coding ICD-10, audiologists are encouraged to include these—such as diabetes or MS—to support medical necessity.
What are co-morbidities?
This is the fixed amount a patient must pay out-of-pocket for covered services before their insurance plan begins to pay.
What is a deductible?
This is a list of set rates used by major payers like Medicare to determine how much a provider will be paid for a specific code.
What is a fee schedule?
Evaluates profitability and solvency over a specific period, representing the "annual check-up."
What is your P&L or income report?
The AMA first developed this system in 1966. It was initially designed to simplify the reporting of medical and surgical procedures.
What is the CPT coding system? In 1983, it was adopted as part of the Healthcare Common Procedure Coding System (HCPCS) to standardize reporting for Medicare and Medicaid
In audiology, HCPCS codes beginning with this specific letter are most commonly used to bill for hearing aids and related supplies.
What is the letter V?
This is a fixed, predetermined amount that a patient pays at the time of a healthcare service.
What is a co-pay?
This concept describes when a third-party is paying for a service, though a lack of it does not necessarily mean a provider won't be reimbursed.
What is insurance coverage?
A "snapshot" of the financial condition at a specific moment, representing the practice's "daily vitals." It is used to determine if the business is positioned to expand, withstand revenue fluctuations, or if immediate steps are required to strengthen cash reserves.
What is your balance sheet?
This federal agency is responsible for managing and updating the HCPCS coding system.
What is CMS or the Centers for Medicare and Medicaid Services?
(POS) Codes imply this________
What is Place of Service?
This occurs when a provider bills a patient for the difference between the provider's charge and the insurance company's allowed amount.
What is balance billing?
These "best practices" (GAAP) provide a standardized framework for how business activities and transactions must be recorded.
What are the General Accepted Accounting Principles?
The organizational framework for all practice transactions. Every financial event is assigned to an account to ensure all money is closely monitored.
What is the Chart of Accounts?
In Audiology, CPT codes generally imply a binaural procedure (both ears), with the notable exceptions of cerumen removal, ABI, and this type of implant.
What is a cochlear implant?
This contains patient info, provider information (name, NPI, tax ID), dates of service, billing codes (CPT codes), diagnostic codes (ICD-10 codes), and the fee paid.
What is a superbill?
This is the percentage of costs of a covered health care service you pay after you've paid your deductible.
What is co-insurance?
This is the actual receipt of payment by a provider for the cost of a service or item.
What is reimbursement?
This professional will be critical as you establish your practice and your BFF when it comes time for taxes
Who is my accountant?