Question
Can an independant audiologist whose practice is located in the same building as a physician bill for medicaid and medicare without any physician referral(for all services, please)?
Answer
Medicare requires a physician referral for all audiology services (Section 2070.3 of the Medicare Carriers Manual). State Medicaid programs must follow federal regulations that are described for individuals with speech, hearing, and language disorders (42 CFR 440.110(c)). These include ''...for which the patient is referred by a physician or other licensed practitioner of the health arts within the scope of his or her practice under State law.''
Steven C. White, PhD Director Health Care Economics and Advocacy American Speech-Language-Hearing Association 10801 Rockville Pike Rockville, MD 20852 phone 301-897-0126 fax 301-897-7356 email swhite@asha.org www.professional.asha.org
Steven C. White, PhD, CCC-A
Director of the Health Care Economics and Advocacy at the ASHA National Office.
Steven C. White, PhD, CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA National Office. White, an ASHA Fellow, is ex officio to the Health Care Economics Committee. His responsibilities include Medicare, private health insurance and Medicaid especially coding and outpatient reimbursement policies as they relate to these payers. White is the staff liaison to the American Medical Association Current Procedural Terminology Editorial Panel and the AMA Relative Value Update Committee. He has published and presented extensively on third party reimbursement. White is co-author with Janet McCarty of Health Plan Coding and Claims Guide (2005), Negotiating Health Care Contracts and Calculating Fees (2004), Appealing Health Plan Denials, and Getting Your Services Covered. White is also coauthor with Ingrida Lusis and Mark Kander of the Medicare Handbook for Audiologists (2005). White holds a PhD in audiology from Wayne State University and an MS in speech-language pathology and audiology from Ithaca College.
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