Tag Archives: ponto

Insurance and Bone Anchored Hearing Systems

Your Frequently Asked Questions, Answered

If you are a practicing audiologist, chances are that you spend some time each week working on billing and reimbursement. Patients want to know what is covered;  you want to get paid for your services and run a profitable business. Audiologists are challenged with maintaining an understanding of billing and coding in an ever-changing healthcare landscape while treating patients using best practices. Your patients rely on you to give them the best service while also maximizing their health insurance benefits.

We know that the billing and reimbursement process can be daunting for busy clinicians. For this blog, we invited Oticon Medical’s Insurance Services Specialist, Brianna Rusay, to answer your most frequently asked questions about reimbursement as they pertain to bone anchored hearing systems (BAHS).

I am new to bone anchored hearing systems. What does my clinic need to prepare for ordering a device for a patient?

Your patient considering a bone anchored device will need to have up-to-date audiological and medical records as they pertain to their hearing loss and diagnosis. They should have a current audiogram performed by a licensed audiologist within the last year and a full medical evaluation by their physician, especially if they are considering surgery. Your patient’s current insurance information should be on file and your office should verify that your practice is in network with their insurance company if you plan to use your patient’s health benefits when ordering the device. You should be prepared to write a letter on your patient’s behalf justifying your choice of bone anchored hearing device as treatment for their hearing loss, and all documentation supporting your choice should be readily available. Finally, your clinic should have an established account with Oticon Medical to proceed with ordering one of our devices for a patient. You can contact your region’s Oticon Medical Clinical Specialist to set up an account with us.

Who looks into the patient’s benefits to see if they have coverage for surgery?

Surgical coverage will depend on both the surgeon and the hospital/surgical center where the surgery is performed. Oticon Medical has a team of insurance specialists who can check benefits and authorization requirements for BAHS surgery, or the hospital/surgical center can request the authorization directly.

Will my clinic be responsible for paying for the surgical supplies? What about the processor?

Reimbursement for the surgery is fully covered with two codes: 69714 and L8690. 69714 is for the BAHS procedure itself and both the facility and the surgeon can bill for this code. L8690 includes the sound processor, abutment, and implant. This code is considered Durable Medical Equipment (DME) and is typically billed by the facility. A DME contract with the insurance company must be in place in order to bill on this code.

What CPT code will I bill for the processor fitting?

Currently, there is no reimbursable code for a BAHS fitting. However, some insurance companies allow the miscellaneous code 92700 to be used for the sound processor fitting. When billing with this code, be sure to include detailed notes about what services will be included for this code and the breakdown of cost.

How will I get paid for my services?

If the insurance company allows it, you may use the miscellaneous 92700 code.  If the insurance company does not cover that code, the patient would be responsible for all fitting costs. Some clinics have chosen to bill the patient a fitting fee for their time spent in fitting the bone anchored sound processor. This fee can vary and can be up to the discretion of the clinic’s billing administrators.

What happens when it is time to upgrade the processor?

Oticon Medical will start the process of upgrades through insurance for your patient. Please refer your patient to our Insurance Services department and we will send them the paperwork to begin processing the request. To process an upgrade request, we will need the following:

  • Two completed intake forms (one from the patient and one from the clinic)
  • A signed prescription for the ordered upgrade (must be signed by a physician)
  • An audiogram (should be within the last year)
  • Medical notes (should be within the last year)

What if the patient is not eligible for surgery?

Many plans still have coverage for BAHS when worn on a softband, though Medicare does consider this a hearing aid and therefore it is not covered. The process for upgrades is the same for new (and upgraded) softband requests. If a patient is interested in wearing a Ponto on a softband, please refer them to our Insurance Services Department so we can begin the process.

What is the CPT code used for a Ponto on a softband?

Whether it is an initial softband request or an upgrade, the HCPCS remains the same: L8692.  This includes the sound processor and the softband.

Contact Oticon Medical’s Insurance Services Department for help

Although you might not know everything there is to know about insurance and benefits, we hope that by increasing your  knowledge and understanding, you feel more confident managing patients and their insurance benefits. If you have any specific questions about insurance benefits as they pertain to Oticon Medical’s Ponto family of devices, please contact our Insurance Services Department at (855) 400-9761 or mailto:insuranceservices@oticonmedical.com.

About the Authors

Brianna Rusay is the Oticon Medical Insurance Services manager. Brianna has a master’s degree in Health Services Administration and over 10 years of health insurance experience. Brianna has worked in both the health care provider setting and the insurance setting, with a primary focus on Durable Medical Equipment.

Dianna Tingle-Gould, AuD, CCC-A is the Clinical Specialist in the Southeast region for Oticon Medical. She has practiced in hospital and neurotology settings in Houston, Texas and Birmingham, Alabama. She completed her training at Auburn University in 2018.

Courtney Smith, M.A., CCC/A, is the Clinical Trainer for Oticon Medical. She in in her 19th year of practicing audiology. She has practiced in private practice and university hospital settings in Las Vegas, NV. She completed her training at the University of Iowa in 2003.

Presidential Perspective

2022 Training Opportunities for Hearing Care Professionals

I consider providing training opportunities to clinicians an important element of being a full-service partner to our professional customers. Sadly, due to global issues beyond everyone’s control, our options to offer live training sessions were greatly diminished since 2020. Fortunately, due to our long relationship with Audiology Online, we were able to continue providing online training, and have had such a positive response to these that even with live trainings returning in 2022, we will continue offering online courses as well.

Below you will find our planned training opportunities, both in-person and online, for the first half of 2022. First though, a word about how we plan to keep everyone safe during our live events.

Live training Covid-19 safety guidelines

The health and safety of our customers is a priority. As states have re-opened and Oticon Medical plans to host in-person customer training, our plans include the following guidelines for all sessions with 10 or more attendees (including Oticon Medical staff). These guidelines are designed for the protection of you, our valued professional customers, as well as our employees and will remain in place until further notice:

  • For live training sessions with 10 or more individuals, attending Demant employees will be fully vaccinated and wearing masks.
  • All customers must sign a waiver stating they understand Oticon Medical will adhere to CDC Covid-19 guidelines for in-person seminars, and that they commit to complying with all rules and restrictions.
  • Some additional requirements may be put in place by the venue in which a training event is being held. The venue will provide attendees and Oticon Medical with any additional guidelines as needed.

And now, speaking of in-person training opportunities, here are the live courses we have planned so far. More will likely be added as the year progresses, so keep in touch with your Oticon Medical representative and check your email for future announcements.

Upcoming New Product Training

We will be offering training opportunities for select customers throughout 2022. As these arise, we will send out email invitations with more details about subject matter, location, and registration. Please keep an eye on your inbox for these exciting future opportunities!

Oticon Medical’s 2022 AAA Course Offerings

Oticon Medical will be offering four in-person training presentations at the 2022 AAA Conference, which is being held in St. Louis, Missouri. We look forward to seeing you at one or more of these sessions:

  • March 31
    • 12:30pm – 1:00pm Rm. IU202: Clinical Evidence Supporting OpenSound Navigator™ & Pediatrics with a Ponto Sound Processor
    • 1:10pm – 1:40pm Rm. IU211: Bone Anchored Hearing Solutions: The Ponto 5 Family & OpenSound Optimizer™
    • 1:50pm – 2:20pm Rm. IU220: Coordinated Adaptive Processing for the Oticon Medical Neuro Cochlear Implant System
  • April 1
    • 1:50p – 2:20pm Rm. IU320: The Oticon Medical Neuro Cochlear Implant System – Latest Technology in Cochlear Implants

To attend, please go to the AAA event’s online registration .

Audiology Online Oticon Medical Courses

Audiology Online will host the following online courses from Oticon Medical. For more details, including CEUs and hours offered, please click through the links provided below. You can check the AO website and your emails from us for announcements of additional courses throughout the year.

  • March 15: The Ponto Implant System: A surgical overview. This course will discuss surgical aspects of the Ponto implant system, including details on Osseointegration, Minimally Invasive Ponto Surgery (MIPS), and MONO surgery, providing valuable information to any clinician recommending bone conduction amplification.
  • April 15: Ponto 5 Mini Advanced Fitting Techniques – Adult and Pediatric Populations. This course will train clinicians on best practices and advanced fitting techniques for fitting the Ponto 5 Mini for both adults and children. This course will use case studies to illustrate examples of challenging fitting scenarios for adults and children.

We look forward to welcoming you to a live training or seeing you on onscreen at one of our live webinars soon!

Presidential Perspective

Why We Launched Good Vibrations Day

On May 3, Oticon Medical launched the first Good Vibrations Day—a nonbranded annual holiday to raise awareness of bone anchored hearing as a solution to hearing losses that cannot be treated with air conduction hearing aids.

Note my use of nonbranded here. The point of this day is to inform people with hearing loss that an alternative to their partial or near-total deafness exists that they might not have known about. And while we are a business that manufactures such a product—the Ponto™ bone anchored hearing system (BAHS) —we are also a part of something much larger: the hearing healthcare community. As such, we consider it our responsibility and our privilege to spread the word about hearing treatment options to those who would benefit regardless of brand.

I can imagine what the cynical among you are thinking as you roll your eyes at your screen: “Sure, John. You don’t care whether this initiative drives Ponto sales. Sell me a bridge, why don’t you?”

Okay, fair enough. Obviously, I believe in our product and that it is the best option on the market. Why would I work for the company otherwise?

Nevertheless, Good Vibrations Day is not about pushing Ponto sales. A surprising number of people affected by hearing loss only know about traditional hearing aids and cochlear implants, which although highly effective treatments, are not universally suited to every form of hearing loss.

Thousands of people in the United States and abroad could be engaging in conversations with friends, listening to music, having an easier time learning in school and functioning at work. Imagine you are one of them, and because of Good Vibrations Day, discover a solution exists that could help you enjoy all the ease and pleasure access to sound provides. Wouldn’t you hop online and start researching all the bone anchored treatment options available? The opportunity to offer this hope to more human beings carries far deeper meaning, to me, than pushing product alone.

Ultimately, we are in the business of helping people. We can only do that if they know our treatment option exists. So, yes, even if our Good Vibrations Day efforts drive some individuals to seek treatment from a company other than ours, we’ll consider it a success.

Which is why we are not only hoping , but actively encouraging, our competitors to join us in celebrating next year’s Good Vibrations Day. Together, we can inform potential users and support audiology professionals in spreading the word about osseointegrated treatments and their effectiveness. The more people we reach who could benefit from bone anchored hearing, the greater the opportunity we will all have to improve lives. And yes, as a rising tide lifts all boats, increasing public awareness of bone anchored hearing solutions will ultimately benefit our entire industry, including our clinical customers.

Until next time,

John Sparacio, President, Oticon Medical US

The Benefits of OpenSound Navigator in Children with Hearing Loss

Fitting children with advanced sound processing algorithms in their hearing devices is not always straightforward. Does the clinical evidence support it? Will it provide more access to all sounds, promote incidental learning, and improve speech understanding in challenging environments? These questions are frequently considered, and a conservative approach is often taken. Whereas, when fitting adults, there is typically clinical evidence to support advanced sound processing and they are better at reporting sound quality issues, so audiologists are more likely to take a less conservative fitting approach. However, if we take too much of a conventional approach with children, are we missing an opportunity to provide improvements in sound quality, hearing in noise, and reduced listening effort?

In 2019, OpenSound NavigatorTM was incorporated into the Ponto 4 sound processor. The success of this sound processing strategy had been seen in Oticon hearing aids with many research studies documenting the benefits provided to patients. So, what is unique about OpenSound Navigator that might provide optimal benefit for children with hearing loss?

OpenSound Navigator is a groundbreaking speech enhancement algorithm that preserves speech and reduces noise in complex sound environments. OpenSound Navigator operates as a holistic system that handles all sound environments from the quietest to the noisiest, by selectively reducing the dominant noise sources while preserving speech in all directions. OpenSound Navigator adapts seamlessly without modes or mode switches. Utilizing an omnidirectional beam that captures a 360° sound panorama of the environment along with a back-facing cardioid that estimates noise from the sides and back provides users with a natural sound experience.

Research has been conducted in children using OpenSound Navigator. Browning et al, 2019 demonstrated OpenSound Navigator improves speech recognition in noise for children. In fact, with speech to the front and noise from behind, OpenSound Navigator provided an average 5 dB SNR improvement as compared to an omnidirectional microphone. Elaine Ng, 2017 further demonstrated that OpenSound Navigator reduces perceived listening effort during a speech recognition task. This benefit is particularly important because hearing loss imposes increased fatigue and effort as experienced by children. Oticon Medical’s BrainHearing™ technology is designed to support the unique day-to-day challenges and developmental needs of children. Together with hearing technology prescribed according to best practice, OpenSound Navigator delivers an optimized speech signal and hence provides these children with the optimal conditions to listen and learn.

Based on the supporting research, we recommend the fitting of OpenSound Navigator in a child’s Ponto™ 4 sound processor starting at one year of age. From ages one to four years, we suggest OpenSound Navigator is active with the transition set to low, and then as the child ages to four years and older, the transition can be adjusted to medium or high similar to adult recommendations. These are the default pediatric settings incorporated into Genie Medical (2019) fitting software. To summarize, unlike conventional directionality and noise reduction technology, OpenSound Navigator does not require children to look directly at the talker the whole time to enjoy better speech understanding in noise. Young listeners may move around freely and can still experience the benefits of OpenSound Navigator.

Another important feature of OpenSound Navigator is that it preserves interfering speech coming from different directions. This new technology allows access to other talkers in the environment, which is fundamental to incidental learning for school-age children.

The groundbreaking technology of OpenSound Navigator marks a breakthrough in the development of speech enhancement systems. It is not only designed to improve acoustics at the child’s ears, but also to facilitate the brain’s own processing. It does not isolate the front talker but preserves access to all talkers. Its accurate and fast spatially informed noise estimator allows the Balance module to selectively attenuate noise sources at given locations. The Noise Removal module removes the remaining noise even between words. OpenSound Navigator opens many possibilities for new pediatric users.

To learn more about the clinical evidence supporting OpenSound Navigator in children we encourage you to register for our upcoming training on April 21, 2021 or reach out to your regional clinical specialist.

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

 

References:

Jenna M. Browning, Emily Buss, Mary Flaherty, Tim Vallier, and Lori J. Leibolda American Journal of Audiology Vol. 28, 101–113, March 2019
Elaine Ng, E. 2017. Benefits of OpenSound Navigator in children. Oticon Whitepaper.
Genie Medical (2019) Fitting Software

 

Clinical Test Protocol for Evaluating Bone Anchored Hearing Benefit During Patient Trial Process

Bone anchored hearing implants are beneficial hearing solutions designed to improve patients’ hearing through direct bone conduction. They are indicated for use in patients who have conductive or mixed hearing loss or in patients with single-sided deafness (SSD).

Adult candidates considering a bone anchored solution have the opportunity to experience sound through an acute simulation during a routine evaluation appointment.  It is during that appointment that the audiologist typically will counsel on device, discuss the benefits and outcomes, and provide the opportunity for the patient to hear sound through a clinic demo device, such as a Ponto 3 SuperPower or a Ponto 4 sound processor. This simulation provides significant value to the patient considering non-surgical versus surgical treatment options.

As clinicians, we are taught the importance of verifying device benefit for patients with hearing loss when considering their hearing device options, and then again as they are being fit with their device. In fact there are well-established protocols and tools in place for hearing aid verifications and cochlear implant assessments. However, there are few recognized protocols in place for validating benefit in a patient using a bone anchored device. It is for this reason that Oticon Medical has developed a bone anchored hearing system test protocol to assess benefit and compare performance with various hearing technologies.

At Oticon Medical, we understand the demands placed on our clinics each day and also know the importance of providing best audiological practice to patients considering a bone anchored solution.  Therefore, we took on the goal developing a simple test protocol for audiologists using the resources already available in their clinic.

The protocol consists of a laminated card outlining four straightforward steps to verify benefit with a bone anchored system or compare performance between different solutions and a test record sheet for documenting the patient’s results. Using published research from Snapp, et al (2010) we modified their suggested protocol to create our version that reinforces the use of a test band for simulations, sound field speech in noise testing using the QuickSin, and the administration of a self-assessment questionnaire. Finally, the protocol outlines additional verification measures that can be completed as well as highlighting the proper reimbursement codes that may be used for this appointment. The protocol is recommended for all bone anchored hearing loss indications.

To learn more about this protocol, we encourage you to register for our upcoming training on February 24, 2021 or reach out to your regional clinical specialist.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

References:
QuickSin Speech-in-Noise Test. User Manual. Etymotic Research Inc. Version 1.3
Current Procedural Terminology (CPT) Codes. Audiology. American Medical Association 2019
Snapp, H.A. et al (2010) A Clinical Protocol for Predicting Outcomes with an Implantable Prosthetic Device (BAHA) in Patients with Single-Sided Deafness. J Am Acad Audiol, 21: 654-662.

Celebrating 10 Years of Delivering Sound that Matters

Part 2 of 2

Part 2 of our series presents evidence that supports the principles championed by Oticon Medical – BrainHearingTM and Direct Sound Transmission. Read below to learn more about these important principles and how they affect patient outcomes based on 10 years of clinical evidence.

Proven Hearing Excellence

As an audiologist, wouldn’t it make your job easier if the simple act of providing a patient with access to sound through hearing technology always equaled excellent outcomes? However, it is not that simple. The right choice of a hearing system will impact every aspect of a recipient’s life – from a conversation with their friend to learning a new subject in school to enjoying a movie at the local theater. At Oticon Medical, our goal is to help our recipients invest their cognitive resources in understanding, remembering, interacting and enjoying, rather than just hearing. We cannot make all situations noiseless and easy, but our solutions should reward the user with increased performance when more effort is necessary to understand an important situation. Through BrainHearing and Direct Sound Transmission, Oticon Medical offers a unique solution for your patients with clinical evidence to support its advantages .

BrainHearing is the Foundation of Better Hearing

BrainHearingTM is the foundation on which we developed the Ponto™ 3 SuperPower (SP) and the Ponto 4 hearing systems. It is about the basic understanding of how hearing works and how the brain makes sense of sound with less effort. Building on our foundation of BrainHearing, we also offer the advantages of Direct Sound Transmission. Direct Sound Transmission delivers the most efficient transmission of speech and sound via the skull bone directly to the cochlea without skin dampening, providing access to a larger range of everyday sounds with less distortion.

The combination of these two principles [BrainHearing and Direct Sound Transmission] demonstrates a significant decrease in listening effort can be achieved with the Ponto 3 SP, as indicated by reduced pupil dilation (Bianchi, F, et al. 2019). This pupillometry study proves that Ponto 3 SP, with its higher MFO level can significantly reduce the effort needed to listen to speech in noise.

An Open and Balanced Sound Experience with OpenSound Navigator

Ponto 4 features the groundbreaking OpenSound Navigator™, offering speed and precision for constant access to 360° sound. The result is a truly open and balanced sound experience in complex listening situations, bringing significant improvement in speech understanding. In fact, clinical evidence indicates a 30% improvement in speech understanding in noise (Bianchi, F, Weile, J N, et al. 2020). Also noted in this same study was that 80% of recipients preferred wearing the Ponto 4 when in a complex listening environment.

These studies show how improved sound quality does not only mean the ability to hear better, but for the first time, learning, memory, and listening effort were evaluated in bone anchored recipients to assess benefits beyond better hearing. The novel research presented here strengthens the evidence that the choice of the system and sound processor may have implications on everyday life activities for your patients. This is why the advanced technology offered by Oticon Medical makes all the difference!

To summarize, ten years after the first recipient received their Ponto sound processor, we have worked strategically to gain insights from surgeons, recipients and clinicians in the field to develop products that improve patient care and outcomes with the Ponto device. Without this research, bone anchored recipients would not be able to benefit from a minimal, suture-free surgical procedure, simple and easy aftercare, improved quality of life and the significant hearing improvements that characterize the Ponto System. To learn more about the studies outlined in this blog please visit our website [insert address].

References:

Bianchi, F, et al. (2019). Benefit of higher maximum force output on listening effort in bone-anchored hearing system users: A pupillometry study. Ear Hear 40:1220-1232.
Bianchi, F, Weile, J N, et al. (2020). OpenSound Navigator™ for Ponto, Oticon Medical white paper 215170.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.

Celebrating 10 Years of Delivering Sound that Matters

Part 1 of 2

As a clinical audiologist, I am rarely awestruck by manufacturing claims; however, I encourage all audiologists in the field to take a moment to review Oticon Medical’s 10-Year Evidence Campaign.  I’ve provided a  brief summary of this two-part series below. Following this review, please reach out to your clinical specialist if you would like additional information or have any questions on the evidence  highlighted in these two blogs.

A Small Procedure with Huge Benefits – The Minimally Invasive Ponto Surgery

When we think of a surgical procedure, I believe most of us envision cutting, sutures, pain and recovery. In fact, the implantation of a traditional bone anchored solution involves an incision, sutures, thinning of the soft tissue and a slower healing process. And like traditional bone anchored solutions, Oticon Medical also followed this path 10 years ago, until the introduction of the minimally invasive Ponto surgery (MIPS) procedure. This procedure has revolutionized the industry by offering patients a less-invasive approach to better hearing with a Ponto™ device. The MIPS technique is a suture-free procedure with a unique approach to tissue preservation that is completed in minutes. It is truly minimally invasive because the soft tissue excised exactly matches the shape of the percutaneous abutment. All preparations for the implant installation are done through this circular incision, eliminating the need for sutures and thinning of the soft tissue. Utilizing tailor-made surgical components, 80% of US surgeons have gravitated to this new procedure offering their patients a simple, safe and easy surgery with huge benefits.

The clinical evidence gathered over the past 10 years supports the benefits of the MIPS procedure  Recent studies suggest that 98% of patients report an improvement in their quality of life after Ponto surgery. The reported improvement is greater than for middle ear implants, and almost as significant as for cochlear implants (Hendry et al., 2016). Additional studies highlighting the features and benefits of the surgical aspects of the Ponto System can be accessed through the link.

Designed for Simple, Easy Care

A topic professionals often counsel patients on during the candidacy process is what type of aftercare is necessary following placement of the implant. Many candidates are reluctant to take that next step towards surgery because of aftercare concerns with regard to the abutment.

In an effort to improve tissue preservation, Oticon Medical has refined the model of the Ponto abutment utilizing a unique OptiFit™ design– offering a straight neck and perfect match to the soft tissue. Because of this design, the Ponto abutment family is a proven skin-friendly concept. What’s more, in 95% of follow-up visits, no skin-related aftercare treatment was required based on systematic literature review reporting on ten years of experience with the Ponto System (Lagerkvist et al, 2020). This indicates that six out of seven patients will not need treatment due to a skin reaction. As a professional, you could then expect less than one follow-up visit in 20 would require the need to take action when using Ponto abutments and the modern surgical technique. These outcomes are representative of what any patient choosing to undergo a Ponto surgery can expect.

New for our family of Ponto recipients is the Ponto Care app. This tool, specifically designed during social distancing times, provides your patients with an Aftercare section allowing them to access relevant information about everyday life with the Ponto, including user guides, instructional videos and a diary. More importantly, the Aftercare section allows recipients to monitor their implant site to ensure proper care is taken should an issue with the healing process occur. The app provides recipients with the ability to photograph their implant site documenting any changes that may occur over time. These photos can be shared or discussed with their healthcare provider should an issue arise during their recovery process, thus empowering patients and enabling simple, easy device care.

Stay tuned as next month we will continue with our 10-Year Evidence Campaign by reviewing the studies focused on Proven Hearing Excellence. 

References:
Hendry J, Chin A, Swan IR, Akeroyd MA, Browning GG.  The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure. Clin Otolaryngol. 2016; 41(3):259-75.
Lagerkvist, H, et al. (2020). Ten years’ experience with the Ponto bone anchored hearing system – a systematic literature review (under review).

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.