I know that the patient is responsible for getting the physician’s order for a hearing test under Medicare, and that we can’t request it of the physician or it is considered solicitation. Can you explain what is meant by solicitation?
Answer
Here is a link to a great piece on the Anti-Kickback statute as well as a great article from the Hearing Journal. In a nutshell, this is how the Medicare system is suppose to function:
The patient reports to a physician that they are having difficulties with hearing or balance. The physician orders a hearing test from an audiologist.
The patient contacts your office. You indicate, to the patient, that if they need a physician order for Medicare coverage that it is their responsibility to obtain the needed order. The patient needs to understand that they will be responsible for the testing if they do not secure a physician order or if the test is for the sole purpose of getting a hearing aid (not medically necessary).
The mere existence of a physician order does not guarantee medical necessity. Medical necessity is determined by the case history.
I hope this is helpful. If you have further questions, please refer to the billing and coding resources provided by the audiology professional associations (AAA, ASHA, and ADA).
Kim Cavitt, AuD
Kim Cavitt, AuD was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. Audiology Resources, Inc. provides comprehensive operational and reimbursement consulting services to hearing healthcare clinics, providers, organizations, buying groups, and manufacturers who want to be better equipped to compete in the managed care and healthcare arenas. She currently serves on the Board of the Academy of Doctors of Audiology and the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/fundamentals-of-audiology-coding-37127Fundamentals of Audiology CodingThis course discusses various coding options used by audiologists. Part one defines audiology CPT, Modifiers, HCPCS and Place of Service codes and discusses their appropriate use. Part two focuses on the basics of IC-10, the most common codes used by audiologists, and how to effectively integrate this new code set into an audiology practice.auditory, textual, visual
This course discusses various coding options used by audiologists. Part one defines audiology CPT, Modifiers, HCPCS and Place of Service codes and discusses their appropriate use. Part two focuses on the basics of IC-10, the most common codes used by audiologists, and how to effectively integrate this new code set into an audiology practice.
2https://www.audiologyonline.com/audiology-ceus/course/icd-10-fundamentals-and-appropriate-29962ICD 10: Fundamentals and Appropriate Use in an Audiology PracticeThis course will focus on the fundamentals of ICD 10 in an audiology practice, including coding scenarios, local coverage determination implementation, and code use.auditory, textual, visual
This course will focus on the fundamentals of ICD 10 in an audiology practice, including coding scenarios, local coverage determination implementation, and code use.
3https://www.audiologyonline.com/audiology-ceus/course/2021-coding-reimbursement-update-356002021 Coding and Reimbursement UpdateThis course will focus on the coding and insurance updates that are new for 2021. We will discuss the CPT changes, MIPS additions, and managed care medical policy and coverage updates.auditory, textual, visual
This course will focus on the coding and insurance updates that are new for 2021. We will discuss the CPT changes, MIPS additions, and managed care medical policy and coverage updates.
4https://www.audiologyonline.com/audiology-ceus/course/ethical-and-legal-requirements-audiology-30065Ethical and Legal Requirements of Audiology Practice - Staying CompliantIn this presentation, we will discuss the foundations of ethics and compliance in audiology, as well as U.S. regulations. We will explore the AAA and ASHA Codes of Ethics, state ethical guidelines contained in several state licensure laws, Medicare, HIPAA, the FDA Guidelines, Stark laws, and Anti-kickback laws and explain, in detail, how they relate to specific scenarios we encounter in audiology.auditory, textual, visual
In this presentation, we will discuss the foundations of ethics and compliance in audiology, as well as U.S. regulations. We will explore the AAA and ASHA Codes of Ethics, state ethical guidelines contained in several state licensure laws, Medicare, HIPAA, the FDA Guidelines, Stark laws, and Anti-kickback laws and explain, in detail, how they relate to specific scenarios we encounter in audiology.
5https://www.audiologyonline.com/audiology-ceus/course/highlights-from-audacity-2016-audiologist-28788Highlights from AuDACITY 2016: Audiologist Assistants - A Good Fit for Your Practice?This course will describe how adding an assistant to your staff can increase practice productivity, efficiency and customer service/patient satisfaction. This course is a recording of a session at the Academy of Doctors of Audiology 2016 AuDACITY conference. Please note: some of the onscreen text is outside the frame, and therefore it is recommended to download the course handout and follow along while viewing.auditory, textual, visual
This course will describe how adding an assistant to your staff can increase practice productivity, efficiency and customer service/patient satisfaction. This course is a recording of a session at the Academy of Doctors of Audiology 2016 AuDACITY conference. Please note: some of the onscreen text is outside the frame, and therefore it is recommended to download the course handout and follow along while viewing.
