Written Referrals and Medicare

Question

Answer

The answer is ''yes''. In the event of an audit and with the current rules, the documentation must be in the records that the referral came from the physician and it was for a medically necessary procedure (i.e., audiogram). The same guideline exists for Medicaid. Documentation must be in the record for the sake of an audit to ensure that the procedure is medically necessary with regard to diagnostic procedures. The exceptions for Medicaid is when there exists a state law mandating newborn hearing screening. In many instances where Medicaid will cover the procedure, it may not be necessary to obtain referrals for that purpose only. But because Medicaid regulations are so different from state to state, it is wide to have a copy of your state's Medicaid regulations or call them to be sure. The last thing you want for either Medicare or Medicaid is to be on the short end of an audit.

Bob Fifer

Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
Mailman Center for Child Development
P.O. Box 016820
Miami, Florida 33101

Street Address: 1601 N.W. 12th Avenue
Miami, Florida 33136

Telephone: 305-243-5937
Fax: 305-243-6921