Medicare, Hearing Care, and Audiology: Data-Driven Perspectives

By Ian M. Windmill, and Barry A. Freeman

This article is a part of the March/April 2019, Volume 31, Number 2, Audiology Today issue.

For the public at large, Medicare evokes the concept of a health insurance plan for the aged or retired population. Created in 1965 to provide a safety net for older individuals who faced substantial medical problems, the benefits available to Medicare beneficiaries are generally more limited than those available through private health insurance plans. Medicare has four parts (Medicare.com, 2018) as summarized in Table 1.

In 2017, there were approximately 58 million persons enrolled in Medicare, of which about 50 million were age 65 or older and 9 million were disabled (CMS.gov, 2019). Enrollment in Traditional Medicare was about 39 million (67 percent), while enrollment in Medicare Advantage programs was about 20 million (Kaiser Foundation, 2018a). Over the next 30 years, the number of Medicare beneficiaries is expected to increase to 92 million people (Kaiser Foundation, 2018b).

The Economics of Medicare and Hearing Care

CMS Tracking

CMS accumulates and tracks data about services provided to Medicare beneficiaries by health-care providers, including audiologists. In the context of economic data, Medicare tracks data such as the number of times a current procedural terminology (CPT) code, which is developed and owned by the American Medical Association (AMA), is billed (utilization) by an individual provider, the total allowed charges for each submitted code, and the total payments to the audiologist for procedures. In addition, CMS tracks the co-morbidities associated with each beneficiary receiving services from an audiologist, the number of beneficiaries served, the number of different (CPT) codes submitted, and the total numbers of procedures billed. As might be expected, CMS also collects data on the beneficiaries, and relates this data to the services provided by audiologists.