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Medicare

Medicare

The Medicare Audiologist Access and Services Act

The Medicare Audiologist Access and Services Act

Issue Brief

H.R. 4056 Representatives Tom Rice (R-SC), Matt Cartwright (D-PA), Mark Meadows (R-NC), Ralph Norman (R-SC), Mike Kelly (R-PA), Jan Shakowsky (D-IL), Brad Schneider (D-IL), Ann Kuster (D-NH), Gus Bilirakis (R-FL), and Lisa Blunt-Rochester (D-DE) introduced HR. 4056 on July 25, 2019. This legislation has been endorsed by the American Academy of Audiology, the American Speech-Language-Hearing Association, the Academy of Doctors of Audiology and the Hearing Loss Association of America. Senators Elizabeth Warren (D-MA) and Rand Paul (R-TN) plan to introduce imminently a Senate companion bill.

Medicare already covers a range of hearing health services, and audiologists are trained and licensed in all fifty states and the District of Columbia to perform these services. However, Medicare currently does not recognize audiologists as providers of most hearing-related services and will only allow reimbursement for a narrow set of tests to diagnose a hearing or balance disorder—and only if patients first obtain an order from a physician. Medicare’s rules are far more restrictive than many private and federal insurance plans. The Medicare Audiologist Access and Services Act ensures that Medicare beneficiaries have access to a full range of hearing and balance health care services provided by licensed audiologists. The bill:

  • Amends the definition of “audiology services” in the Medicare statute, which specifies the services that audiologists may provide, to include all services already covered by Medicare that are also within an audiologist’s scope of practice.
  • Amends the Medicare definition of “practitioner” to include audiologists, which improves beneficiary access to audiologic and vestibular care, a change that is consistent with Medicare’s classification of similar health care providers such as clinical social workers and clinical psychologists. 
  • Makes technical changes to the classification of audiology services in the Medicare system as “other diagnostic tests” to remove the pre-treatment order requirement, which does not exist with any other federal or commercial payer; and
  • Makes no change to the scope of hearing health benefits covered by Medicare or the scope of practice of audiologists.

View Issue Brief (PDF) | View Press Release (PDF) 

CMS Issues Proposed Payment Rules for 2020

Late Monday, July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) posted the Proposed Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (OPPS) Rules for 2020. These comprehensive rules contain proposed policy and payment changes under the Medicare program.

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CODING AND REIMBURSEMENT | Potential Pitfalls in Cochlear-Implant Billing and Reimbursement

As cochlear implant awareness increases and more individuals receive cochlear implants, the demand for related audiological services is growing across the country. To meet this need, many audiologists have begun to add, or are considering adding, cochlear implant services to their practices. 

Topic(s): Coding, Reimbursement, Practice Management, Centers for Medicare and Medicaid Services (CMS), Medicare, Medicaid, Cochlear Implants (CI)

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Publication Issue: Audiology Today July/August 2019

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CODING AND REIMBURSEMENT | Advanced Beneficiary Notice of Noncoverage Use: Mandatory or Voluntary?

Understanding the correct use of the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 is important to ensure billing compliance for traditional Medicare (Part B). Audiologists may face challenges determining when Medicare covers a service and when an ABN is required. Federal law requires that providers, including audiologists, must notify a Medicare beneficiary in advance when a service that Medicare typically covers is likely to be denied and/or when the item or service is not considered by Medicare to be medically reasonable and necessary. The ABN meets this requirement.

Topic(s): Medicare, Coding, Reimbursement, Centers for Medicare and Medicaid Services (CMS), Balance/Vestibular

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CODING AND REIMBURSEMENT | New Medicare LCD Process—What You Need to Know

Local coverage determination (LCD) policies issued by Medicare administrative contractors (MACs) serve as the workhorse of Medicare coverage policy. About 90 percent of coverage determinations are made through LCDs. Coverage policies include a defined list of services the insurer will cover and specific exclusions. Medicare provides coverage of services that are determined to be “reasonable and necessary” for Medicare beneficiaries. If a specific item or service is not covered under an LCD, this does not mean it isn’t covered. Claims may be adjudicated on a case-by-case basis.

Topic(s): Coding, Reimbursement, Practice Management, Medicare, Medicaid, Local coverage determination (LCD), Medicare administrative contractors (MACs), Centers for Medicare and Medicaid Services (CMS)

Publication Issue: Audiology Today May/June 2019

Audiology Today Mar/Apr 2019…What’s Inside This Issue?

The editorial team and I are so happy to announce the content for this latest issue of Audiology Today. We are featuring a number of comprehensive, relevant, and interesting articles, as well as some short reads on public relations, coding and reimbursement, and audiology advocacy.

Read more

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CODING AND REIMBURSEMENT | Coding Update: Contralateral Routing Device

The American Academy of Audiology (the Academy) and others recently requested revisions for codes and code descriptors in the CROS/BiCROS family and Centers for Medicare and Medicaid Services approved many of the proposed changes. The groups requested the changes to reflect changes in CROS/BiCROS technology. 

Topic(s): Audiologist, Binaural, Behind The Ear (BTE), Bilateral microphones with contralateral routing of signal (BiCROS), Contralateral Routing of Signal (CROS), In The Ear (ITE), Hearing Aids, Coding, Reimbursement, Practice Management, Medicaid, Medicare, Fitting, Sensorineural Hearing Loss

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Publication Issue: Audiology Today March/April 2019

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

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.  

Topic(s): CPT - Current Procedural Terminology, Medicaid, Medicare, Coding, Reimbursement, Practice Management

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Eyes, Ears, & Teeth

In the March/April 2018 issue of Audiology Today, I compared the professions of audiology and optometry and examined some of the successes of optometry in establishing autonomy and an expanded scope of practice. You may want to stop here and give it a read. I’ll wait.

Glad you came back.

Topic(s): Bone-Conduction Implant (BCI), Cochlear Implants (CI), Medicaid, Medicare, Middle Ear, Coding

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CODING AND REIMBURSEMENT | CMS Includes Audiologists in the QPP

Under the final Quality Payment Program (QPP) rule for 2019, the Centers for Medicare and Medicaid Services (CMS) announced that audiologists will be considered “eligible clinicians” for QPP participation, effective January 1, 2019. The QPP replaced the Sustainable Growth Rate (SGR) formula that for many years served as the underpinning of Medicare provider payment. 

Topic(s): Audiologist, Medicaid, Medicare, Coding, Compliance, Reimbursement, Practice Management