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20Q: Working with Medicare - Reimbursement Rules of Engagement

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1.  The primary resource to determine coverage policies for audiology services through Traditional Medicare is the ___________, while private plans have a _____________ that will vary from payer to payer and plan to plan. Medicare Managed Care Manual; Summary of Benefits Medicare Benefit Policy Manual; Summary of Benefits Medicare Benefit Policy Manual; Evidence of Coverage Medicare Managed Care Manual; Evidence of Coverage

2.  Which of the following is true regarding audiology coverage policies under Traditional Medicare and Medicare Advantage plans? Traditional Medicare Part B benefits pay for hearing examinations for the purposes of prescribing, fitting, or adjusting a hearing aid. Traditional Medicare Part B benefits pay for audiologists to provide auditory rehabilitation and counseling services. Medicare Advantage plans cannot cover hearing aids because they have to have the same coverage policies as Traditional Medicare. Medicare Advantage plans must provide coverage equal to Traditional Medicare but can provide additional benefits.

3.  Through Social Security Act statutes, Medicare-covered audiology services are made payable under the auspices of which of the following? Other Diagnostic Tests Otorhinolaryngology Services Rehabilitative Services Vision and Hearing Services

4.  Which of the following would be considered medically necessary according to the Medicare Benefit Policy Manual for Part B services? Annual hearing examination to re-assess hearing status without patient complaint or concern of any changes to otologic status. Hearing examination sought with the intended purpose of obtaining a hearing aid. Hearing examination to evaluate status after medical treatment for hearing or balance issues. Repeat hearing examination for individuals who are not at risk for changes in hearing status.

5.  Which of the following is true about changes to the physician order requirements under Medicare’s limited direct access provisions added in 2023? The changes eliminated the medical necessity requirements for a subset of Medicare-covered audiology services to increase access for Medicare beneficiaries. The changes eliminated the need for audiologists to refer to physicians for concerns of medical otologic issues. The changes eliminated the physician order requirements for a subset of Medicare-covered audiology services when the suspected hearing issue is non-acute. The changes eliminated the physician order requirements for all Medicare-covered audiology services when the suspected hearing issue is non-acute.