Question
I have an audiologist performing hearing tests at a rehab facility one day per week. The otolaryngologist has office space at the facility and the equipment is her own. Will these services be reimbursed by Medicare since the place of service would be "office" or will they be denied because the patient is technically an in-patient stay?
Answer
This is a question that I had not encountered before. I contacted someone in Medicare and also a Medicare expert in ASHA to ensure that I give you the most accurate information. The consensus among the three of us is that the patient's status will determine how reimbursement goes. Rehab facilities have two classes of patients: those who are admitted for Medicare Part A services and patients whose Part A days have expired and who now have Part B coverage. It will be necessary to discern the Medicare status of the patient (Part A or Part B) before testing begins.
Ideally, if the patient is Part A, the audiologist (or the corporate practice) should have a contract with the rehabilitation facility to cover payment for the services. Audiological services delivered to Part A patients are treated the same as if the patient had in-patient hospital status and are considered part of the overhead payment to the facility. These services provided by consulting professionals should be paid by the facility rather than Medicare. Audiological services delivered to rehabilitation facility patients who have used their 100 days of Part A eligibility and are now Part B should be billed as if they were outpatients. Billing and reimbursement are handled through the Physician Fee Schedule directly to Medicare on a CMS 1500 form.
As a slight caveat, I recommend contacting your carrier just to make sure that there are no local decisions that could affect your billing or your procedure selection. Technically, all of our diagnostic procedures are covered by Medicare, but the carriers sometimes have local decision policies that influence how we bill. If the patient has a Medicare HMO, then you will need to obtain authorization in the same way as for a non-Medicare HMO patient for any outpatient services.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the immediate Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
