Is Requesting a Physician’s Order for a Hearing Test Considered Solicitation?

Question

Answer

Here is a link to a great piece on the Anti-Kickback statute as well as a great article from the Hearing Journal. In a nutshell, this is how the Medicare system is suppose to function: 

1. The patient reports to a physician that they are having difficulties with hearing or balance.  The physician orders a hearing test from an audiologist.
2. The patient contacts your office.  You indicate, to the patient, that if they need a physician order for Medicare coverage that it is their responsibility to obtain the needed order.  The patient needs to understand that they will be responsible for the testing if they do not secure a physician order or if the test is for the sole purpose of getting a hearing aid (not medically necessary).

The mere existence of a physician order does not guarantee medical necessity.  Medical necessity is determined by the case history.

I hope this is helpful.  If you have further questions, please refer to the billing and coding resources provided by the audiology professional associations (AAA, ASHA, and ADA).