If a patient insists on an annual hearing test, and they have Medicare, do you bill Medicare and let it be denied or do you have the patient pay out of pocket at the time of service and not bill?
Answer
If I had a patient insisting they wanted to bill Medicare, we have to do that, because we're a mandatory claim submitter. I would have that patient sign an ABN. The ABN that they sign would say that that you don't think Medicare will cover it, because it's not medically reasonable or necessary and that they can be financially responsible if it is not covered. And then if they selected option one, you would bill it with a GY modifier. I would have the patient pay at time of service as a GY or GZ modifier will drive a denial.
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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