Section 426.419 - Recordkeeping RequirementsAn audiologist must maintain a medical record for each member for a period of at least as long as the minimum period required by 130 CMR 450.205(G). The MassHealth agency does not pay a provider for services if the provider does not have adequate documentation to substantiate the provision of services payable under MassHealth. The medical record must contain all pertinent information about the services provided, including the date of service and the dates on which materials were ordered and dispensed. In no instance does the completion of the appropriate MassHealth claim form, the maintenance of a copy of such a claim, or the simple notation of service codes constitute sufficient documentation for the purposes of 130 CMR 426.419. The recordkeeping requirements are specific to each type of service and are described as follows.
(A)Cochlear Implant External Components. The audiologist must maintain the following information in the member's medical record: (1) A history of the member's hearing loss and use of the cochlear implant. The history must contain the following information:(a) the make, model number, type, and date of purchase of the cochlear implant external components;(b) a description of any speech and hearing therapy received by the member; and(c) a description of any medical condition that the member has that may impair vision or affect cochlear implant use.(2) The manufacturer's invoice indicating the actual acquisition cost of the cochlear implant external components, including all discounts, and the warranty indicating the terms of repair or replacement in the event of loss of or damage to the cochlear implant external components.(B)Earmolds. The audiologist must maintain the manufacturer's invoice in the member's medical record, indicating the actual acquisition cost for the earmold.(C)Hearing Aids. The audiologist must maintain the following information in the member's medical record:(1) a history of the member's hearing loss and use of hearing aids. The history must contain the following information:(a) the etiology and chronology of the member's hearing loss, including the member's age at the onset of the loss and an indication of whether the hearing loss is progressive;(b) the make, model number, type, and date of purchase of each hearing aid previously worn by the member;(c) a description of any speech and hearing therapy received by the member; and(d) a description of any medical condition that the member has that may impair vision or affect hearing-aid use;(2) all audiological evaluations. The evaluations must have been performed no more than six months before the dispensing date of the hearing aid;(3) the medical clearance from a physician obtained in accordance with 130 CMR 426.414(B); and(4) the manufacturer's invoice indicating the actual acquisition cost of the hearing aid, including all discounts, and the warranty indicating the terms of repair or replacement in the event of loss of or damage to the hearing aid.(D)Replacement Hearing Aids.(1) If the member's hearing aid has been lost, the audiologist must maintain in the member's medical record a statement from the member or someone acting on the member's behalf (for example, an immediate family member or other legal representative), that describes the circumstances of the loss of the hearing aid.(2) If the member's hearing aid has been irreparably damaged, the audiologist must maintain in the member's medical record a statement from the manufacturer documenting that the hearing aid cannot be repaired.(E)Accessories/Options. The audiologist must maintain in the member's medical record the manufacturer's invoice indicating the actual acquisition cost of all accessories/options.(F)Audiological Evaluation. The results of all audiological evaluations must be fully documented in the member's medical record.(G)Office Visits for Evaluation and Management Services. The audiologist must maintain in the member's medical record documentation substantiating the necessity of the office visit and detailing the services provided.(H)Refitting Services and Other Professional Services. The audiologist must maintain in the member's medical record documentation substantiating the necessity of the office visit and detailing the services provided.Amended by Mass Register Issue S1277, eff. 1/2/2015.