Reimbursement Process for Miracle-Ear

Amplifon Hearing Health Care reimbursement model

We want to let you know about some changes to our reimbursement model and the various ways Amplifon Hearing Health Care and Miracle-Ear are committed to growing our partnership. Here are important things you need to know:

Reimbursement process changes

Right now, you receive reimbursement for your services based on the technology tier of the hearing aid purchased by Amplifon Hearing Health Care members. Beginning January 2021, the reimbursement will change to a flat fee reimbursement model rather than be dependent on the hearing aid model and technology level sold. We recognize you devote the same amount of time to your patients, no matter what technology level is fit. To that end, reimbursement will be more commensurate with your time rather than with the technology sold.

Bonus opportunity

An opportunity to earn a bonus of up to $500 per hearing aid is available to Miracle-Ear franchisees, based on clinic conversion rates. Because we value our partnership and want to find ways to collaborate and help grow your patient community, this bonus is only being offered to Miracle-Ear franchisees and gives Miracle-Ear the opportunity to potentially earn more than under the previous reimbursement model. This Bonus will be paid out by Miracle-Ear based on the scheduled detailed below.

Here is how the process will work

Your opportunity to earn the additional reimbursement is determined by the percent of funded and/or discount referrals that are converted to orders each quarter

  • 60% referral-to-sale conversion required for funded members
  • 35% referral-to-sale conversion required for discount members
  • Funded and discount conversion thresholds are tracked independently and paid out independent of one another
  • When you meet the funded conversion threshold (at or above 60%), you earn the bonus for funded sales
  • When you meet the discount conversion threshold (at or above 35%), you earn the bonus for discount sales
 
  1. Payout based on performance at the franchise (CF) level.
  2. All referrals (including clinic self-referrals) are included in the referral-to-sale conversion calculation
  3. Conversion calculation for bonus payout done at the end of the following quarter
  4. Workers’ Compensation referrals and sales excluded from bonus program

Here's how you will be reimbursed and the bonus opportunity available:

2021 Provider Reimbursement Rates

Flat fee

Bonus

Total Potential Earnings

Commercial and Medicare Advantage

$500 per hearing aid

$500 per hearing aid

$1,000 per hearing aid

Medicaid

$300 per hearing aid

$300 per hearing aid

$600 per hearing aid

Here’s the timing of the bonus program.

Any hearing aid dispensed in 2020 will be reimbursed at current rates. Any hearing aid dispensed beginning January 1, 2021 will be reimbursed at the new rates. This means you may see some reimbursement checks at the beginning of 2021 for 2020 patients that are being paid out at the old rates in the new year. The date in which you dispense the hearing aid will drive the payment schedule.

Amplifon will honor the 2020 reimbursement rate for any order placed in 2020 and the Receipt-of-Delivery (ROD) paperwork submitted to Amplifon by January 31, 2021. All 2020 orders submitted after January 31 will receive the updated 2021 provider reimbursement.

Reporting showing Amplifon referrals and units will be available for review.

  Q1 Q2 Q3 Q4
Referral End Date 3/31/2021 6/30/2021​ 9/30/2021​ 12/31/2021
Conversion End Date 6/30/2021 9/30/2021​ 12/31/2021 3/31/2022
Bonus Review Period Jul 2021​ Oct 2021 Jan 2022​ Apr 2022​
Bonus Payout Timing 8/1 – 8/15 2021 11/1/ - 11/15​ 2021 1/31 - 2/14​ 2022 5/20 – 5/16 2022

Amplifon is investing in ways to collaborate and increase patient referrals

In our effort to restore sound and to serve more patients, Amplifon Hearing Health Care is strengthening our value proposition to become the preferred hearing benefits administrator for U.S. health insurers.   It’s equally important we find ways to deepen our partnership with Miracle-Ear franchisees to bring additional patients to your locations.

This includes:

  • Miracle-Ear as the preferred provider partner, pending clinic availability and conversion rates
  • Offering a new hearing aid formulary in 2021 that features Miracle-Ear products
  • Driving more Medicare Advantage referrals through targeted Medicare Advantage plans
  • Helping patients book appointments directly with Miracle-Ear locations

Thank you for all you do to help our patients regain their sense of hearing and reconnect with life! We value our partnership and look forward to our future together.

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