Question
I understand Medicare does not reimburse for an audiogram unless it is part of a medical evaluation referred by a physician. However, what if during a hearing aid check it is apparent there is a decrease in hearing that requires further testing and medical intervention. If we advise the patient to contact her physician for followup and to request a referral for a hearing evaluation does this violate any Medicare quidelines? Or in another case, a hearing aid user drops in with a reported sudden hearing loss and we perform the necessary tests then have her follow-up with her physician, would Medicare reimburse if the Audiologist is the first professional contacted?
Answer
Medicare has a strict requirement of "medical necessity". In the case of the first scenario where it is apparent during a hearing aid check that hearing is worse, I would take it upon myself to call the physician of record, convey what you are seeing, and seek either a referral or his/her blessing to repeat the audiogram. Then, the audiologist must write up a complete report including the following:
The motivation for the audiogram (i.e. change in hearing apparent during the hearing aid check), consultation with Dr. __________, request by Dr. _____________ to repeat the audiogram. Then you describe what you did, what you found, your interpretation of the results, and your recommendations. Sign it and date it - and make sure that Dr. _________________ receives a copy to place in the patient's medical record.
If a patient comes for a sudden hearing loss complaint, under the Medicare system, do not pass "Go", do not collect "$200", go right to the MD. Again, I would call the MD to grease the way and see if he/she wants you to perform the audiogram before the patient goes to Dr. ______'s office. If so, then what I have described above would apply to the report. But the additional factor about a sudden onset hearing loss, it is extremely important to expedite the situation to get the patient into the MD for evaluation. There are a myriad of causes of sudden onset hearing loss, with some of them time is not the patient's friend.
Politically and professionally, it is always good to take the initiative when you notice a change or something that would constitute "medical necessity" and justifiable services and call the physician of record. That is called looking out for the patient's welfare. Usually, physicians appreciate that, and it doesn't violate any Medicare regulations. But be sure to do a complete report for your records and for the patient's physician.
Dr. Fifer is the Director of Audiology and Speech-Language Pathology at the University of Miami's Mailman Center for Child Development. He is also a member of ASHA's Health Care Economic Committee and ASHA's representative to the AMA's Relative Value Update Committee / Health Care Professions Advisory Committee.
