Medicare

Medicare Audiologist Access and Services Act of 2019 Introduced in the Senate

On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced the Medicare Audiologist Access and Services Act of 2019 (S.2446).

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President’s Message: Get Involved

Message from the President: Lisa Christensen, AuD | September 2019

As summer winds down, people return to school, and we all resume our regular duties, what better time than to think about how you can be more involved in the Academy’s activities. I want to fill you in on a few ways that you can be involved.

Submit Nominations for the Board of Directors—Due September 20

I can tell you first-hand how rewarding it is to serve on the Academy board. We are seeking candidates to fill one president-elect position and three board member-at-large positions.

I am the chair of the Nominations Committee, and I ask you to send in a nomination for a colleague or yourself. It is simple—review the steps on our website here.

Our volunteers are critical to advancing our initiatives, and we are delighted that many members will assume new volunteer positions on October 1, including leadership roles on the board, councils, and committees. The volunteer portal re-opens next spring, but at any time you can sign up for the volunteer reserve to fill spots as they become available.

Support the Medicare Audiologist Access and Services Act of 2019

We urge you to send letters to your representatives and senators to encourage their support of the bill. Check out our legislative action center for sample letters, and sign up for the Grassroots Network to be more engaged.

Promote Balance Awareness Week…September 15-21

The Academy is pleased to have worked with VeDA (the Vestibular Disorders Association) to collaborate on a poster, infographics and Ask the Expert articles. Resources are available here on the Academy’s website for your use. Please spread the word!

Share Your Knowledge, Research, and Expertise at AAA 2020 + HearTECH Expo in New Orleans

Submit your abstract proposal by October 1. Visit www.AAAConference.org for more information.

Get Ready…It Is Coming Up Soon; National Audiology Awareness Month starts October 1

Download resources, fact sheets, posters, and other materials to help promote and celebrate this month.

Join Me for the President’s Year in Review: Looking Back and Looking Forward for Audiology

As I wrap up my term as president at the end of this month, I will offer a retrospective in a eAudiology webinar on September 25 (.1 CEUs).

Are you confused and worried about the state of our profession and our Academy? This presentation will help YOU identify key issues facing the field of audiology and then give YOU some tools to help YOU start to influence OUR profession.

Thank You

And, lastly, a huge thank you to Jackie Clark as she moves out of the immediate past president position, but also to Tracy Murphy, Chris Zalewski, and Bopanna Ballachanda who move out of their member-at-large positions. I will truly miss working with all of you over the next year, and a big thank you to all Academy members who have made this a very enjoyable year for me. Thank you, and I look forward to seeing all of you on the September webinar.

Lisa Christensen, AuD
(Twitter handle: @AuDLeadership)

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Audiology Today Sept/Oct 2019…What’s Inside This Issue?

Take a look at the table of contents and delve into these online articles, which you can now easily search by topic, title, or author.

AUDIOLOGY ADVOCATE | Time to Activate to Advocate

With the 116th Congress already over a quarter under way, the Government Relations Committee (GRC) urges Academy members to get involved. It is an exciting time for audiology, with the Academy actively working and collaborating with other organizations on new policy initiatives. The audiology voice in numbers is critical for the profession in advancing these initiatives.

Topic(s): Advocacy, Patient care, Hearing, Hearing Aids, Hearing Loss, Healthcare, Medicare Audiologist Access and Services Act, Centers for Medicare and Medicaid Services (CMS), Medicare, Balance/Vestibular, Adult

Author(s):

Jodi Baxter

Susan Pilch

Publication Issue: Audiology Today September/October 2019

CODING AND REIMBURSEMENT | When and Why to Modify

Billing modifiers were created to provide additional information to the payer about the performed procedure(s) and help describe and/or qualify the services provided. There are common modifiers used by commercial payers and the Centers for Medicare and Medicaid Services (CMS), that indicate to the payer that the services provided have been altered in a way that is different than the ascribed definition of the billing code. For example, a modifier should be used when all of the tests in a bundled code were not performed or when only one ear was tested.

Topic(s): Centers for Medicare and Medicaid Services (CMS), Medicare, Advance Beneficiary Notice (ABN), CPT - Current Procedural Terminology, Coding, Reimbursement, Practice Management, Patient care, Treatment

Author(s):

Jennifer Frank

Anna Marie Jilla

Publication Issue: Audiology Today September/October 2019

The Medicare Audiologist Access and Services Act

Issue Brief

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 H.R. 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. On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced an identical companion bill in the Senate (S. 2446).

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)

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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.

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)

Author(s):

Christine Brown

Publication Issue: Audiology Today July/August 2019

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

Author(s):

Kristiina Huckabay

Kari Morgenstein

Publication Issue: Audiology Today March/April 2018

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