Question
With the advancement of Medicare legislation pertaining to rehabilitative and audiological services, what guarantees as audiologists do we have that we will not be placed under a reimbursement cap? How will ASHA confirm this prior to passage of the bill that would expand Medicare benefits for audiological services?
Answer
Obviously, there is no sure-fire guarantee that the comprehensive audiology legislation will pass in 2011 or 2012 or 2013. Please note that Congress does not like the therapy cap for physical therapy, occupational therapy, or speech therapy. The therapy caps were instituted as a measure to control spending for therapy services. There's a good likelihood that by the time a comprehensive audiology benefit would be passed there would be no more therapy caps. Medicare has been working on resolution of the therapy cap for quite some time. We expect to see the cap eliminated within the next couple of years.
The comprehensive audiology legislation is being drafted in such a fashion that the sections of the Medicare statute are very specific to audiology services. The section that includes the Medicare therapy cap is not even close to the amended sections. Additionally, if the therapy cap was included, ASHA would ask the congressional sponsor to pull the legislation.
Editor's Note: This Ask the Expert was taken from the live e-seminar The Potential Risks Versus the Need for a Comprehensive Medicare Benefit recorded 6/16/2011. To access the complete course, please go here.
Steven C. White, Ph.D., CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA, and has spent thirty years in government relations at ASHA. White, an ASHA Fellow, is ex officio of the Health Care Economics Committee and staff liaison to the Current Procedural Terminology Editorial Panel and the Relative Value Update Committee. He is co-author of Health Plan Coding and Claims Guide, Negotiating Health Care Contracts and Calculating Fees, Appealing Health Plan Denials, Medicare Handbook for Audiologists and Medicare Handbook for Speech-Language Pathologists. He holds a M.S. in speech-language pathology and audiology from Ithaca College and a Ph.D. in audiology from Wayne State University.