Current through Register Vol. 54, No. 7, April 4, 2022
(a) The hearing aid provider, in any and all
settings, shall keep legible individual records as are necessary to fully
disclose the kind and extent of service(s) provided, the HCPCS procedure code
being billed, and proof of medical necessity for those services.
Documentation of services performed by
the hearing aid provider shall include, but may not be limited to, the
1. The date of service;
2. The name of beneficiary;
3. The reason for visit;
4. Evaluation findings;
5. The service(s) provided;
6. Follow-up procedures or visits, if
7. The signature of the
dispensing provider rendering the service(s); and
8. Other documentation required to support
the services billed to the Medicaid program.
(c) Written records required to support
services billed to the Medicaid/NJ FamilyCare program shall be made available
for review and/or inspection if requested by the Department of Medical
Assistance and Health Services (DMAHS).
Further discussion of the extent of
documentation requirements can be found at
, 9.8 and 9.9.
(e) The hearing aid provider's involvement
shall be clearly demonstrated in notes reflecting the provider's personal
involvement with, or participation in, the service rendered.
Hearing aid providers shall make
documentation available to Medicaid/NJ FamilyCare staff during post-payment
audits. Providers who repeatedly overbill or fail to follow hearing aid
candidacy criteria or Program regulations may be required to have all of their
claims prior authorized.
The provider shall
maintain copies of all records, including, but not limited to, the following:
i. Otologic reports;
ii. FD-36, FD-244, FD-257, and CMS 1500 claim
iii. Documentation to
support the need for replacement aids; and
iv. Repair invoices.
(g) Copies of all records shall be
kept and maintained by the provider for a period of at least five years from
the date the service was rendered.
N.J. Admin. Code §
Amended by R.2001 d.71,
See: 32 New Jersey Register 3965(a), 33 New Jersey Register 793(a).
In (b)2, substituted "beneficiary" for "recipient"; in (d),
amended N.J.A.C. references.
Amended by R.2006 d.289, effective
New Jersey Register 1385(a), 38 New Jersey Register 3304(a).
(b)7, substituted "dispensing provider" for "dispenser"; in (c), inserted
"made", and substituted "DMAHS" for "DMA & HS"; in (e), substituted
"provider's" for "dispenser's"; in (f), substituted "shall" for "are required
to"; in (f)1, substituted "provider" for "dispenser"; and in (f)1ii,
substituted "CMS" for "HCFA".
Amended by 53 N.J.R. 2222(a), effective