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AMP II > Final Exam (New Material) > Flashcards

Final Exam (New Material) Flashcards

1
Q

what is SII

A

Calculates % of speech info that is audible and usable to the listener

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2
Q

SII of 50%

A

50% of speech cues supporting intelligibility are audible in a quiet setting

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3
Q

Increase in # of dots

A

frequency region with higher contribution to intelligibility (HF)

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4
Q

Decrease in # of dots

A

frequency region with reduced contribution to intelligibility (LF)

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5
Q

purpose of measuring LDL

A

needed to ensure amplified output doesn’t exceed the individual’s loudness tolerance

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6
Q

interpretation of LDL

A

normal is between 100-105

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7
Q

purpose for ANL

A

Quantifies a listener’s willingness to listen to speech in the presence of background noise.

Identifies those who will have more difficulty adapting to amplification

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8
Q

how to score ANL

A

MCL value – BNL value = ANL score

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9
Q

low anl score

A

difference <7
Indicates the patient ACCEPTS a lot of noise background noise w/o issues
This patient is likely to wear hearing aids on a regular basis

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10
Q

high anl score

A

difference > 13 dB
Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly
Premium technology

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11
Q

ANL scores b/w 8-12 dB

A

equivocal
May require extra post-fitting counselling or adjustment period

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12
Q

purpose of SNL

A

Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids

Each patient will need tailored technological recommendations based on their individual “signal-to-noise loss.”

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13
Q

0-2 snr

A

normal
omni or may benefit with directional mic

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14
Q

2-7 snr

A

mild loss
recommend standard directional mics

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15
Q

7-15 snr

A

moderate
beamforming as well as standard directional mics

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16
Q

> 15 snr

A

severe
requires remote mic in addition to beamforming and directional mics

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17
Q

rem ref mic

A

monitor and calibrate the soundfield speaker output, maintaining the desired signal intensity at the measurement point

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18
Q

retention cord

A

to stabilize and maintain the reference microphone’s position
Blue stretchy coard

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19
Q

probe tube

A

measure the intensity of the signal arriving to the TM

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20
Q

prob mic

A

collects and measures sound from the probe tube attached to it
Stem

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21
Q

Aided output of 15dB in needed to achieve binaural benefit

A

true

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22
Q

type I signal

A

brief puretone signal swept over variety of frequencies
verifies MPO
DFS can attenuate this signal
doesn’t show the affect of compression or channel interactions on output signal

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23
Q

type II signal

A

complex speech like signals
BB signal over different intensities
mimics speech
might not show all spectral issues because we cannot capture every little detail

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24
Q

types of type II signal

A

standardized
nonstandardized

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25
Q

standardized speech signal

A

calibrated
repeatable
verifies device can reach prescriptive targets

ex: speech map, ISTS, ICRA

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26
Q

nonstandardized signal

A

not used for programming
good for counseling
less repeatable

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27
Q

speech envelope

A

Visual representation of modulated speech sounds

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28
Q

LTASS

A

long term average speech spectrum
Measured by averaging a measured signal for 10 seconds

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29
Q

what are factors that impact its average value

A

will change with varying vocal effort, mic position, and language

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30
Q

vocal effort influences

A

mid frequency LTASS avg

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31
Q

mic position influences

A

HF LTASS avg

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32
Q

tonal languages influence

A

LF LTASS avg

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33
Q

Speech envelope has a crest factor of +____dB (louder speech signals) & valleys of - ______ dB (soft speech signals)

A

12 18

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34
Q

crest factor and valleys define the representative ______ of normal convo speech over time

A

dynamic range

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35
Q

The difference between the valleys (softest signal) and peaks (loudest signal) of speech is

A

~30dB SPL

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36
Q

Difference bw threshold & LDL represents

A

dynamic range

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37
Q

what is room mean squared error

A

how close the measured output is to the prescribed target

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38
Q

what is RMSE criterian

A

5dB

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39
Q

what are the calibration methods

A

substitutioin method of soundfield equalization
modified pressure methdos

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40
Q

substitution method equalization

A

Done before the PT arrives, placed at where subject’s head would be, stored as a reference point, used to calibrate the reference mic and probe
Impacts results if the subject changes location or moves

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41
Q

modified pressure concurrent equalization

A

reference mic monitors test signal throughout test to equalize and adjust, calibration signal replays every 10 seconds (pink noise segment)

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42
Q

modified pressure stored equalization

A

probe is calibrated one time on PT’s ear & stored for fitting process
Used to avoid ref mic contamination (stops it)

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43
Q

what is ref mic contamination? what is used to stop it?

A

happens when amp output escapes ear canal through open dome

Modified pressure “stored equalization”

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44
Q

Probe tube Calibration & Acoustic Transparency

A

probe microphone module cannot be physically located in the ear canal; the probe tube serves as an extension to the probe microphone
Probe tube tip is placed directly over the reference microphone during calibration. This protocol accounts for the different intensities arriving to the probe microphone module’s reference mic and through the probe tube.
The unit mathematically adjusts the intensity differences removing the tube’s resonance effects.
This procedure makes the probe tube “acoustically invisible”

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45
Q

ANSI Recommendations & Working Distance

A

Distance allowed bw PT and speaker (18”-36”)
Reflective surfaces & tester: 2 x WD (about 34-36 in away)
Ambient noise in the room must be 10dB lower than REM signal
Horizontal plane: 0º azimuth: greatest reliability
Vertical plane: speakr should be level to the PT’s ear in order to accurately measure HF output

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46
Q

RE

A

real ear

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47
Q

r

A

response

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48
Q

g

A

gain

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49
Q

what is R

A

absolute measure of SPL output arriving to the TM

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50
Q

what is gain

A

diff bw output intensity and input intensity

output - input = gain

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51
Q

REUR

A

measurement of the absolute SPL level of an open ear canal response, across all frequencies, at the tympanic membrane (input + gain + resonance = output)

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52
Q

REUG

A

the measurement of gain increase resulting from pinna, ear canal, and head diffraction effects, as measured from an open ear canal
REUR - input = REUG

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53
Q

REOR

A

A measurement of insertion loss occurring because of the presence of a mold/dome in the ear canal

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54
Q

why do we do REUR

A

Knowing a patients ear canal resonance improve accuracy of prescriptive fitting

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55
Q

REUR changes due to

A

ear canal differences
Size, texture, shape, or presence of abnormal anatomy
Age: pediatric, adult, elderly
One person can have 2 different REUR’s

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56
Q

REOR

A

A measurement of insertion loss occurring because of the presence of a mold/dome in the ear canal

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57
Q

why do we do REOR

A

Lets us see if the vent effect is performing as expected
To identify which low frequencies are released due to the vent effect
To determine if the vent introduced undesired standing waves

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58
Q

REAR

A

absolute aided output and frequency response when a hearing aid is turned on

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59
Q

why do we do REAR

A

To view devices absolute aided output in a unique ear canal (if you don’t measure it, you don’t know if you’ve met your objective)

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60
Q

Measures intensity of the output signal arriving at the TM, when the input signal is sufficiently intense to drive the device to its maximum power output level

A

REAR 85/90

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61
Q

REIG

A

The difference between the AIDED response and the UNAIDED response of the ear canal
REAR- REUR = REIG

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62
Q

RECD

A

difference between the SPL resonance of a 2cc coupler and the SPL resonance of the real ear

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63
Q

why do we measure RECD

A

accurately converts HL thresholds using inserts to SPL values creating a personalized conversio factor for precise conversions

predicts the real ear output when HA measurements are made in the test box

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64
Q

the natural resonance resulting from the pinna and ear canal effect that the patient walked in the door with

A

REUR

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65
Q

the insertion loss that results from the mold/dome

A

REOR

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66
Q

the output arriving to the TM when aid is turned on

A

REAR

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67
Q

the amount of gain added to the input signal when the aid is turned on

A

REIG

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68
Q

the MPO that’s arriving to the TM

A

MPO/RESR/REAR85/90-

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69
Q

difference between the SPL resonance of a 2cc coupler and the SPL resonance of the real ear

A

RECD

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70
Q

How does an SPL-ogram differ from an audiogram. Why will measurement of the RECD improve the accuracy of the conversion?

A

SPL-o-gram is in dB SPL (physical sound level), while an audiogram is in dB HL (normalized against normal hearing thresholds).
Audiograms are used for diagnosing hearing loss, whereas SPL-o-grams are more common in hearing aid fitting because they show the actual sound level being delivered to the ear.
It creates a customized conversation to create accurate fitting targets for the patient.

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71
Q

RECD ANSI standards

A

Can be made with a custom earmold or foam insert
The same coupler must be used for both measurements - ANSI requires the use of HA-1 coupler

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72
Q

pink line in RECD

A

real ear measurement

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73
Q

green line in RECD

A

green

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74
Q

dots in recd

A

HA-1 RECD avg

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75
Q

blue line in recd

A

actual ha-1 recd measurement

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76
Q

if RECD is above avg

A

smaller ear canal than avg

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77
Q

if RECD is below avg

A

larger ear canal than avg

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78
Q

If RECD is negative in LFs below 1000

A

slit leak

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79
Q

if RECD is negative in LFs below 1500

A

pe tube or perf

80
Q

Negative RECD >10dB in the 4-6 kHz region

A

blocked probe tube

81
Q

increase in the mid frequencies in RECD

A

fluid

82
Q

open mastoid cavity in RECD

A

decreases in mid to highs

83
Q

MEE in RECD

A

increases REC in mids

84
Q

proprietary formula

A

developed by manufacturers

85
Q

NAL-NL2

A

loudness equalization formula
balances perception of loudness over a range of frequencies (LF has more energy so it increases mid and highs until it equals)

uses REIG
provides tonal language targets
adults
if PT wants increased intelligibility

86
Q

NAL-NL2 formula

A

Early formulas used Lybarger ½ gain rule
Calculates gain targets as 50% of the threshold loss.
Revised formula calculates gain targets as 46% of threshold loss

CURRENT: bases gain recommendations on the Speech intelligibility Index % (SII)
More gain is prescribed to those sounds that contribute the most to speech intelligibility

87
Q

NAL-RP

A

profound losses
Gain is calculated as 66% of the threshold loss rather than 46% of loss

88
Q

NAL-NL2 calculation for A-B gaps

A

25% of the air-bone gap is added to the NAL-NL2 formula

89
Q

DSL 5.0

A

loudness normalization formula
maxes audibility to assist lnaguage development
uses REAR
provides MPO targets
adults & kids
PT desires increased comfort or REUR is not avg

90
Q

Maximized audibility formula

A

Speech Intelligibility Index (SII) Audibility targets

91
Q

Is it acceptable for an audiologist to change the prescription, applying gain that does not meet the “+/- 5 dB for target” criteria?

A

Begin by following +/- 5dB match target rule as a good general guideline
However, make further adjustments based on PT complaints
The line must match the shape (contour) of the targets that are present

92
Q

When you adjust a band, you adjust the entire speech envelope up and down

A

TRUE

93
Q

When you adjust a channel, you either adjust bottom or the top of the speech envelope

A

true

94
Q

move bands, raise soft sounds, then raise loud sounds - maintain balance bw

A

all the CR TKs

95
Q

Frequency lowering verification and modification

A

Verify audibility of HFs /s/ sound
Adjust FL to MOAF as needed
Use the /s/ stimulus on audioscan to assess HF audibility

96
Q

goal of FL

A

add the least amount of FL required to put the upper shoulder of /s/ response into the MAOF

97
Q

too much audibility fr FL

A

poor sound quality

98
Q

what is aided functional gain measures

A

Compares aided thresholds to unaided thresholds using puretone signals in the sound field
The purpose of hearing aids is to get the persons aided thresholds as close to normal conversation levels as possible

99
Q

why do functional aided testing

A

REM equipment is not available
Gooey cerumen clogs probe mic
Pediatric fittings or uncooperative patients
CI, BAHA, or Lyric fittings
Some federal government agencies require the test

100
Q

limitations to aided testing

A

Test retest reliability is poor
Varies by 10-15dB
Only verifies threshold of audibility
Aided thresholds are invalid for near-normal hearing (usually in the low frequencies)
The reason for this is because ambient noise masks the test signal resulting in a poorer aided functional gain response
Hearing aid features could suppress audibility of tones
limited frequencies - can miss ranges critical for speech understanding
Doesn’t reflect real world listening
Lack of speech information

101
Q

conformity protocols

A

Used to ensure HAs are providing the appropriate amplification based on the PTs hearing needs

On-Ear Real Ear Verification
RECD measurement and Test Box Programming
Aided functional gain
Aided speech intelligibility measures
Aided subjective ratings
Subjective speech intelligibility judgments
Speech quality judgments
Loudness rating

102
Q

Closer the lines are the higher the

A

CR is

103
Q

Further lines go apart

A

more linear

104
Q

The closer they are the more compression that is added

A

true

105
Q

If we shift tk up and down it impacts signal at kneepoint but not the rest of the signal

A

true

106
Q
A
107
Q

Aided output needs to be ______ bw ears to support binaural advantage

A

15 SPL

108
Q

ILD -

A

HF > 3

109
Q

ITD

A

LF <850

110
Q

Strategies for binaural advantage

A

Fit better ear first
Relies on this for communication
Fit poorer ear second after good ear is optimized

111
Q

Asymmetric HL

A

Asymmetric threshold loss: 3 adjacent frequencies >20dB or 1 frequency >25 dB

SII: if the speech signal audible frequencies arecritical to understanding

SNR loss: 20% difference

discomfort levels: are tolerance levels significantly different

112
Q

fitting asymmetric HL

A

may need to try one or more formulas (create multiple memories for different ones)

use formula for severe losses when needed

provide useful info to aid localization to help the PT

113
Q

considerations to fitting unilateral vs bilateral devices

A

how does each ear contribute to SI in isolation

amoutn of useful audibility in each ear

will bilateral help binaural benefit

114
Q

when do you need special fitting considerations for NIHL

A

type III

115
Q

how to fit type I and II NIHL

A

disable FL

add audibility to residual hearing (threshold x .2 = 65dB of gain)

add 5-8dB to normal range before the precipitous drop

enable expansion when hearing is near normal below 2 (reduces mic noise)

verify audibility of s

enable & adjust FL 4-6 wks after first fit

116
Q

Type III NIHL fitting

A

add gain to thresholds below 85 dB

balance audibility from 5-3 below 85 dB

add 5-8dB to normal before precipitous drop

enable expansion when eharing is near normal below 2

if threshold is near LDL do not add gain or add 2% of threshold vs normal 46%)

117
Q

receiver considerations

A

add gain to the healthier areas of the cochlea in lows and mmids
no need for receiver with wider frequency responses with extenced HFs

118
Q

fitting for reverse slope HL

A

add only 15-20dB in low and mids
add 10-15 at 2kHz and above even if they are WNL
allow habituation time

add additional MF gain in 5dB periods of habituation (be cautious of LF adding)

once LF and mids are adjusted, modify HF based on PT perceptions & increase by 5-10dB

119
Q

dead regions fitting

A

1-2 no special

> 3: benefit from HF gain bw 1-4 kHz

120
Q

which Rx doesn’t account for ab gaps

A

DSL

121
Q

how do you account for additonal gain for ab gaps

A

Calculate prescriptive gain recommendation for AC threshold
Calculate 25% of A-B gap. This additional gain is added to the AC prescriptive targets
Increase MPO by the same percentage used for A-B gap calculation allowing headroom for the extra gain

122
Q

perf fittings

A

decrease in LFs by 8dB so adding gain here is not beneficial

options: bc/bone anchored device, will path effect ear level device

123
Q

sev to profound fittings

A

Reduced reliance on audibility and they rely on other communictive strategies

use NAL-RP, low CRs and slow acting compression

freuency lowering might help

124
Q

Raising or lowering TK modifies output for

A

soft sounds

125
Q

Improving sound quality

A

increase/decrease loud signals (channels)
increase/decrease LF bands

126
Q

Increasing or decreasing MPO manages

A

very loud signals (90+)

127
Q

Improving clarity or comfort

A

increase/decrease HF bands
increase/decrease soft signals (channels)
increase/decrease loud input signals (channels)

128
Q

how to determine if own voice complaints are from amp or shell origin

A

check the physical device (push in or pull out mold)

ask if it changes when they speak at different intensities

129
Q

voice improves when pushed in

A

increase canal length of device or improve aperture seal

130
Q

Sound improves with it pulled out slightly

A

increase vent size or shorten canal length

131
Q

no difference when checking physical fit

A

amp origin and change gain/output

132
Q

Worse when they are louder

A

Indicates saturation or excessive gain
Adjust mpo or loud input

133
Q

Worse when they speak softer

A

Insufficient gain
Increase LF band or soft inputs

134
Q

No difference when they speak

A

OE

135
Q

if sounds better when device is on

A

shell origin
modify shell

136
Q

if there is no differences when it if off vs on

A

probably shell

137
Q

if it sounds better with device off

A

amplifier origin
modify device gain/output

138
Q

how to manage hf amp origin

A

increaswe gain in mids

139
Q

Describes own voice as sounding like an echo, lispy, raspy or muffled
Report an unnatural perception of their voice coming from somewhere else

A

hf amp origin

140
Q

own voice complaints from shell origin

A

Prevalent when LF thresholds are <40 dB HL
continues when device is off
manage: open vent or increase length

141
Q

own voice complaints from LF amp origin

A

complaint stops when HA is off

manage: lower LF band 4-6dB (if it doesn’t work incrase LF band 4-6)

change loud LF channel first

142
Q

HF amp origin

A

Describes own voice as sounding like an echo, lispy, raspy or muffled
Report an unnatural perception of their voice coming from somewhere else

manage: increase mid gain

143
Q

how to fix paper complaints

A

reduce loud channel at all frequecies first

144
Q

PT will say Having trouble listening in noisy environments when at shopping mall with family and they are talking to me
Background noise is pretty constant in this scenario
Traffic
Museum or Shopping center
Multi-talker babble
Heavy machinery

A

improve speech intelligibility
Decrease the LF bands & increase th HF bands

can raise the TK to attenuate soft LF interference

145
Q

what can you do to improve sound quality

A

increase/decrease loud channels
increase/decrease LF bands

146
Q

what can you do to improve clarity or comfort

A

increase/decrease HF bands
increase/decrease soft signals (channels)
increase/decrease loud input signals (channels)

147
Q

crockery, clattering
Household electrical appliances
Water running
Paper rustling
Vacuum

A

HF weighted noise
tolerance of noise

increase LF band under 1500 Hz
decrease HF band above 1500 Hz

148
Q

increasing CR in loud

A

decreasing loud input
this makes loud sounds less audible & more comfy

149
Q

decreasing CR for loud

A

increase loud input
this makes the loud sounds more crisp and clear

150
Q

increase CR soft

A

increase soft sounds to make it more audible (louder)

151
Q

decrease CR soft

A

decrease soft sounds to make it less audible (quieter)

152
Q

ex of LF weighted background noise

A

shopping mall
traffic
museum or shopping center
multi talker babble
heavy machinery

153
Q

ex of HF weighted background noise

A

Crockery (dishes, plates, cups, etc.), clattering
Household electrical appliances
Water running
Paper rustling
Vacuum

154
Q

what to do for HF weighted noise

A

increase LF & decrease HF bands

155
Q

what to do for LF weighted noise

A

decrease LF & increase HF bands

156
Q

how to increase comfort in LF noise

A

increase CR (decreasing loud input) in LF channel by 1-2 dB
raisae LF tK 50dB below 1500 Hz

157
Q

what to do for party noise/wedding

A

raise HF tk to 60dB (decreases soft HF sounds)

158
Q

dishes clattering

A

decrease loud HF gain (increase CR)
decrease MPO

159
Q

utensils

A

lower loud channel at all frequencies

159
Q

water running

A

decrease MPO

160
Q

what to do in bars/parties/weddings

A

increase HF TK to 60dB

increase HF compression ratio to lower loud HF sounds

161
Q

what should you do for a music program

A

disable directional mic, DFS, DNR, make it more linear and raise MPO

162
Q

grocery bag complaint

A

change moderate HF sounds

163
Q

how to reduce toilet flushing

A

decrease LF loud channel

164
Q

if HA sounds boomy

A

decrease LF bands
decrease overall gain
decrease MPO

165
Q

HVAC complaint

A

raise TK
lower soft LFs
add more expansion??

166
Q

what to program for music

A

Disable LFdirectional mic, DFS, DNR, make it more linear & raise MPO (higher crest factor so gives it more room)

167
Q

There is no ‘long-term average” for instrumental music and therefore targets prescriptive fitting formulas are unavailable

A

true

168
Q

Crest factor of +16 to +18 dB whereas speech is assumed to be +12 dB

A

true

169
Q

The output waveform of music is “peakier” relative to speech

A

true

170
Q

Describe the 3 considerations made to determine if manual memories are warranted

A

are they in challenging environments a lot
can they cognitively and physically understand and manage additional manual programs
can the program make a noticeable difference

171
Q

when is noticeable difference achieved most

A

Threshold loss at 500 Hz is is >40 dB
HF loss is not too severe (70dB HL or better)

172
Q

other factors for determining if manual programs are useful

A

Individuals with wider dynamic ranges may benefit from additional manual memories
Milder losses with poor than expected SNR loss require manual programs to control noise in their environment.

173
Q

when will Medicare cover

A

Only covers diagnostic procedures needed to diagnose an auditory disorder
Tests of auditory and vestibular systems, tinnitus, auditory processing and osseointegrated devices
Does cover treatment for auditory disorders as speeh-language pathology services

174
Q

what does medicare not cover

A

HA
Vestibular treatment/rehab
Aural rehab
Cerumen management

175
Q

qualified audiologist

A

licensed as an audiologist by the State in which the individual furnishes such services

176
Q

who can be paid for an audio

A

Just an audiologist

177
Q

Medicare will not pay for services done by

A

4th year AuD students, audiological aides, assistants, technicians, hearing instrument specialists or others who do not meet the qualifications

178
Q

100% supervision

A

Procedures can only be billed to Medicare with the Preceptor’s NPI only if they interact with you and the PT 100% of the time of the procedure

179
Q

when can we provide non acute hearing tests every year without an order

A

when it isn’t related ot
isequilibrium or HAs
Exams for prescribing, fittings or changing HAs
Only relates to Medicare (Part B) beneficiaries only
Medicare advantage plans usually do not require a physician order (unless specified in your agreement)

180
Q

If the audiologist performs a test without an order they are not covered even if they discover a pathological condition

A

true

181
Q

non acute

A

still need medical necessity but they do not need to see a physician first

182
Q

who can write orders

A

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)

183
Q

a physician writes an order for a PT to get a VNG. What can the audiologist perform?

A

Only the CPT descriptor the order specifies

184
Q

If the physician order diagnostic audiological tests without naming specific tests, the audiologist can select the appropriate test battery

A

true

185
Q

Despite med necessity, you can only perform the test code that the physician sends

A

ture

186
Q

recomendation from a DR for a PT to see another provider like a specialist; directs the PT to another medical provider for specialized care
f

A

referral

187
Q

more broad; directive order to perform tests, procedures or treatment results in service being provided

A

order

188
Q

what constitutes medical necessity

A

Services must be necessary based on the PTs diagnosis or symptoms
Re-evaluation is needed due to suspected change in hearing, tinnitus, or balance
Eval is needed to determine cause of a disorder
Eval is needed to determine effect of medications, surgeries or other treatments
Re-eval is needed to follow-up on changes in hearing, tinnitus, or balance caused by an established diagnosis (comorbidity) that puts a PT at risk for change including
otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Meniére’s disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions;
Failure of a screening test
Diagnostic eval of cochlear or BS implant and programming
Audiological diagnostic tests before and periodically after implantation of auditory prosthetic devices
Physician refers related to signs associated with HL, balance disorder, tinnitus, ear disease, or ear injury

189
Q

bundled pricing model

A

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

190
Q

benefits of bundled

A

Practice can easily estimate revenue generation based on number of amplification units dispensed each month
Billing protocols are less complicated

191
Q

what are disadvantages to bundled

A

giving away:
Cost of time spent completing a formal Communication Needs Assessment
Cost of time spent on quality control checks and preprogramming
Cost of time spent verifying, programming, finetuning, and finetuning, and finetuning
Cost of time spent completing paperwork for warrantied services
Cost of time spent cleaning the device
Cost of time spent on annual HAC; In-office repairs, reprogramming when thresholds change
Cost of time spent visiting with patients who just “really like visiting you!”

192
Q

A PT who comes in once every month compared to one that comes once every year gets a better deal because they are geting more for what the paid for

A

bundled

193
Q

unbundled pricing

A

Separates cost of technology from all other associated services
Pay as you go:
Allows the consumer to readily differentiate the cost of the device, accessories from YOUR services
Provides the consumer with the opportunity to be selective in choosing the level of services
Reduces the price differential between low, mid-range and high-level technologies as the cost of your services is fixed, regardless of the technology level
Allows consumers to purchase devices through other platforms and then receive only the service components from the audiologist

194
Q

challenges of unbundled

A

3rd party payers expect providers to unbundle billed services
Durable medical goods (devices) are reimbursed separately from services
Submission of a single bundled fee reduces reimbursement
Knowledge of reimbursement fee schedules to determine the combination of codes needed to optimize payments received is challenging & time consuming.
Insurance reimbursement polices varies from company to company and within plans.
Requires you to know your hourly costs to calculate cost of services

195
Q

Requires you to know your hourly costs to calculate cost of services

A

unbundled

AMP II (7 decks)

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