N.J. Admin. Code § 10:64-1.4

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:64-1.4 - Recordkeeping

(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.

(b) Documentation of services performed by the hearing aid provider shall include, but may not be limited to, the following:

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 required;

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).

(d) Further discussion of the extent of documentation requirements can be found at N.J.A.C. 10:49-9.7, 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.

(f) 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.

1. 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 forms;

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 § 10:64-1.4

Amended by R.2001 d.71, effective 3/5/2001.
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 8/21/2006.
See: 38 New Jersey Register 1385(a), 38 New Jersey Register 3304(a).
In (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 12/20/2021