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Coding and Reimbursement Q & A

Kim Cavitt, AuD

March 20, 2017

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Question

Where can I find official word that audiologists do not need to participate in PQRS reporting in 2017, to show to my office manager?

Answer

It is in the final rule of the MIPS program, the Merit-Based Incentive Payment System, where it shows that audiology is an ineligible provider until 2019.  Go to cms.gov and look at Medicare, Merit-Based Incentive Payment System final rule for 2016, search the document for audiology, and you will find that we are on the ineligible list.

What do you do when an insurance company demands a letter of medical necessity to cover the cost of hearing aids?

In that case, you write a letter of medical necessity that explains why those hearing aids are medically necessary for the patient in front of you to participate in their own healthcare decisions and in the quality of life. In my experience, especially when the patient's coverage is linked to accident, illness or injury, you should write a letter of medical necessity, and the physician should write one as well.

Can you recommend amplification on a physician report?

Yes. The fact that amplification is an outcome does not make testing non-covered.
 
This Ask the Expert were taken from the course, Coding and Reimbursement Update for 2017 & Beyond - access the course here.


kim cavitt

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 providers. Dr. Cavitt is a Past-President of the Academy of Doctors of Audiology (ADA), a Representative to the Audiology Quality Consortium (AQC), a member of the State of Illinois Speech Pathology and Audiology Licensure Board, and Vice President of Government Relations for the Illinois Academy of Audiology.  She also serves on committees through ADA and ASHA and is an Adjunct Lecturer at Northwestern University.


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