Question
Please address the impact of new HCFA rulings on reimbursement for audiology services. Can you anticipate the timetable for these changes to occur?
Answer
The information I have indicates that payment will be less of a hassle, but will not yet be perfectly smooth sailing. Audiologists will not be able to bring Medicare patients off the street for routine hearing tests and expect to be paid for testing them. There will still need to be a referral from a physician, and the basis for the evaluation must still fall under the guise of ''medical necessity''.
The primary difference is that the ambiguity of payment based on outcome should be removed. For example, in the past, when a Medicare patient was evaluated, and it was clear that the patient would be a hearing aid candidate, there was much uncertainty and consternation about whether to bill in the event that Medicare performed an audit. Now, that concern has been removed. Even if active medical treatment is not warranted, the audiologist can still be paid for the work performed. Therefore, the outcome of the test is no longer the basis for payment. That change was to have taken effect May 29, 2001.
The other change regarding vestibular testing applies to ''qualified audiologists''. Under Medicare guidelines, a qualified audiologist is one who is duly licensed by the state in which the individual practices. If the state does not have license, then the individual must meet essentially the same requirements as necessary for the ASHA CCCs. If an audiologist does not meet these requirements, or the tester is not an audiologist, then there must continue to be direct supervision by a physician.
The third HCFA ruling allows audiologists to bill Medicare directly for services provided to residents of skilled nursing facilities (SNFs) under Medicare Part B. A previous Program Memorandum incorrectly bundled audiology services with speech-language pathology services which must be paid under consolidated billing requirements. This correction will be in effect July 1, 2001.
BIO:
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 originally served as the representative of the American Academy of Audiology in the submission and revision of audiology CPT codes in 1995. Since then, with the exception of one year, he has worked as a member of the coding committee for the American Speech-Language-Hearing Association. He also serves as a consultant to state agencies in Florida regarding audiology coding issues.
