Business of Audiology Flashcards
Does medicare only cover the diagnostic procedures needed to diagnose an auditory disorder?
Yes
“Routine” services and annual studies are not typically covered
Audiologic treatment, is not covered (hearing aids, vestibular, treatment/rehabilitation, aural rehabilitation, cerumen management)
What is the medicare category for audiologists?
Other diagnostic tests
Not under a therapeutic category (like SLPs)
Who can be reimbursed for audiology services?
Just an audiologist
If the state let’s physicians perform an audiogram, then they can be reimbursed for that (needs to be in their scope of practice and in the state regulations)
Can audiologic aids and assistants complete testing and be reimbursed for it?
No
Medicare is not authorized to pay for these services
Hearing instrument specialists are also not reimbursed
Can audiology students be reimbursed?
No
But medicare does allow reimbursements under the preceptors NPI when you are observed 100% of the time
Preceptor needs to participate in the care of the patient
Can audiologists bill for non-acute hearing assessments every 12 months without a physician order?
Yes, new as of 2023
Still needs to be medical necessity
Needs to be unrelated to disequilibrium and hearing aids
Does a physician order need to be written for acute hearing assessments and vestibular services?
Yes
To have medicare coverage
Who can provide a physician order when needed?
Certified Nurse Midwives
Clinical Nurse Specialists
Clinical Psychologists
Clinical Social Workers
Interns, Residents and Fellows
Nurse Practitioners
Physicians Assistants
Physicians (MDs or DOs, Dentists, Podiatrists, or Doctors of Optometry)
Can you only complete the tests that are on the physician order?
Yes
Unless the practitioner orders diagnostic audiological tests by an audiologist without naming specific tests (then the audiologists can choose the tests
You want open-ended orders
Will a physicians order guarantee reimbursement?
Contractors shall pay for audiological diagnostic tests based on the reason for the test and not on the person who ordered it
If a physician orders a test but has no appropriate diagnostic or medical use for the results, then the reason for the test may be questioned
Need to have medical necessity to receive reimbursement
What services are reimbursable?
Medicare pays for audiological diagnostic tests under the benefit for “other diagnostic tests”
Audiological evaluations include tests of the auditory and vestibular systems, tinnitus, auditory processing and osseointegrated devices
What can medicare not reimburse for?
Audiological treatment, including hearing aids
Treatment for beneficiaries with disorders of the auditory systems as speech-language pathology services (therapy services)
What constitutes medical necessity?
The service is not being performed for the convenience of the patient or health care practitioner
The services supplied must be necessary based on the patient’s diagnosis, or symptoms
Re-evaluation is needed due to suspected change in hearing, tinnitus, or balance;
Evaluation is needed to investigate the cause of a disorder
Evaluation is needed to determine the effect of a medication, surgery or other treatment
Reevaluation is needed to follow-upon changes in hearing, tinnitus, or balance caused by an established diagnoses (comorbidity) that place the patient at probable risk for a change in status
Does medicare pay for audiological services “incident to” the service of a physician?
No
“Incident to” services are billed using the physician’s NPI, but are performed by ancillary or non-physician personnel (i.e., technicians, nurses or audiology assistants)
What is the bundled pricing model?
Consumer prepays for all current and future services at the time of purchase
Bundled pricing includes the cost of devices and all associated services or all fees associated with product are combined into the initial cost for a predetermined length of time during which office visits are provided at no charge
