Patient care

Patient care

Coding and Reimbursement Main Image

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

Feature Story Main Image

ARC19: Advances in Amplification

Hearing aid processing no longer operates under the assumption that the real-world listening environments are represented by simple laboratory test conditions, such as the talker of interest is in front with noise behind, or even that there is only a single talker of interest. In addition, the driving philosophy has shifted from treating a single complaint (e.g., understanding in noise) to holistically treating individuals across the full range of their real environments and experiences (e.g., connecting to an auditory world).

Topic(s): Amplification, Research, Hearing, Hearing Assistive Technologies (HAT), Hearing Aids, Hearing Health Care, Patient care, Treatment

Author(s): 

Publication Issue: Audiology Today September/October 2019

Feature 3: Story image

How to Effectively Access and Collaborate with Early Hearing Detection and Intervention Systems

Public health agencies, in conjunction with Early Hearing Detection and Intervention (EHDI) programs, monitor the results of newborn screening outcomes, newborns with risk factors for the late onset of hearing loss, the prevalence of confirmed hearing loss, the type and degree of these losses, and the number of babies enrolled in services. A public health system is the best way for all of the parties providing hearing care to a child to have access to the results of the provided care. 

Topic(s): Pediatric, Early Hearing Detection and Intervention (EHDI), Patient care, Treatment, Hearing

Feature 2: Story image

Our Responsibility to Move Audiology Forward

A culture of quality is needed if we are to bring audiology into the spotlight and highlight our expertise in hearing and balance. Ritz-Carlton co-founder and former president Horst Schulze states that we can create transactions every day, but until we place the person next to us as the most important person in the world in that moment, we will never create an experience.

Topic(s): Professional, Patient care, Public Awareness, Centers for Medicare and Medicaid Services (CMS), Coding, Reimbursement, Practice Management, Hearing Assistive Technologies (HAT), Balance/Vestibular, Hearing Aids, Hearing Health Care

Author(s): 

Publication Issue: Audiology Today September/October 2019

Feature 1: Story image

Decoupling Professional Audiological Services from the Sale of Hearing Devices

Background

Helping adults manage hearing loss is by far the most fundamental aspect of audiology practice, making this the bread and butter of our profession. Hearing instruments play a crucial role in managing hearing loss in adults (Ftouh et al, 2018; Laplante-Lévesque et al, 2010).

Topic(s): over-the-counter (OTC) hearing aid devices, Patient care, Treatment, Hearing Aids, Hearing Assistive Technologies (HAT), Hearing Health Care, Audiologist

Know How image

KNOW HOW | Changing Times Will Revitalize Audiology Services

Audiology services and provisions are changing following the passage of the over-the-counter (OTC) hearing aid legislation. In the end, what that will actually mean is still unclear. Likely, we will see a device that can manage mild hearing loss for patients and give them some options for their hearing health care. Those of us who have practiced for many years are still trying to decide how that will fit into our current practice model and whether to incorporate an OTC product in the clinic. 

Topic(s): Patient care, over-the-counter (OTC) hearing aid devices, Audiometric Test, Tinnitus, Cochlear Implants (CI), Hearing, Balance/Vestibular, speech-in-noise, Bluetooth, Professional

Curious About How Sleep Works?

Do you hear that buzzing? No, it is not tinnitus. It is the alarm clock attempting to rouse you out of bed. Hopefully, you woke up having had a good night of sleep.

Read more

Ask the Expert: Concussion

Ask the Expert: Concussion

Physical Therapist: Shelly Massingale, PT, MPT

1. Concussion has received significant media attention over the last few years. What is a concussion? 

The CDC defines concussion as “a type of traumatic brain injury or TBI- caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”  Concussion is commonly referred to as a mild traumatic brain injury (mTBI) and is typically associated with normal structural imaging (normal CT/MRI). Symptoms of concussion  can include dizziness, headache, cognitive changes, mood changes, balance problems, and nausea and vary from person to person and from injury to injury.  Concussion is considered a transient injury that typically lasts a few days to a several weeks before full recovery.  

2. Dizziness and balance problems are common after concussion. Why are these symptoms so common?

Dizziness and balance problems that occur after a head injury are often the result of damage to either the peripheral or central vestibular system.  Our vestibular system is comprised of our inner ear (peripheral vestibular system), the vestibular nerve (connects the peripheral to the central vestibular system), and the areas in the brain that process that information (central vestibular system).  If any of these areas have been affected, the injured person could experience feelings of dizziness, being off balance, vertigo or a combination of these.  Our vestibular system is highly sensitive to movement, so any damage or disturbance to these areas cause symptoms while performing activities of daily living. 

3. Do you recommend that patients pursue vestibular rehabilitation after a concussion?

If a patient sustains a concussion and has any symptoms of dizziness, vertigo, imbalance, or nausea that last more than a few days, I highly recommend pursuing vestibular therapy. Vestibular therapy an effective treatment, and having a specialist take you through a course of treatment will allow you to recover more quickly. The patient’s physician typically makes the initial referral to vestibular therapy after a thorough medical evaluation of concussion.

4. If so, what vestibular rehabilitation techniques help to reduce symptoms and improve function?

The technique used in vestibular therapy depends on the nature and severity of the symptoms, as well as the underlying cause. When someone sustains a concussion, symptoms of vertigo may occur with positional changes. This diagnosis is called Benign Paroxysmal Positional Vertigo (BPPV), which commonly occurs after head injury. The treatment for BPPV is very specific and should be performed by a trained clinician. If BPPV is not present, then balance exercises and vision retraining exercises that address how the head and eyes move together are very effective in reducing dizziness and imbalance. Exercises selected are highly specialized and very specific to the individual’s symptoms and daily activity demands, and should only be performed by a clinician that has training in this type of therapy.

5. Are there specific exercises or strategies most helpful for improving symptoms after concussion?

See above answer 4.

6. Do you recommend vestibular rehabilitation for all patients post-concussion? Are there patients with certain symptoms who benefit most?

Vestibular therapy is not indicated for every patient who sustains a concussion.  Some people will be diagnosed with a concussion and will not have any symptoms related to dizziness, imbalance or vertigo. These patients do not need to participate in vestibular therapy.  On the other hand, any person who is experiencing dizziness, vertigo, and/or imbalance after sustaining a concussion would likely benefit from participating in vestibular therapy, especially if the symptoms persist for more than a few days. 

7. I’ve had quite a bit of neck pain and stiffness after a car accident. Could this be the cause of my dizziness?

Cervicogenic dizziness can occur with a whiplash injury and is often diagnosed with concussion. Cervicogenic dizziness is defined as the presence of dizziness, imbalance or unsteadiness related to movements or position of the cervical spine or related to a stiff or painful neck. The treatment for cervicogenic dizziness is therapy for the neck to help decrease the discomfort and stiffness. Reducing stiffness and muscle imbalance in the neck can help to decrease the sensation of dizziness.

8. Are there any screening measures or tests available that you’d find helpful to have prior to seeing a patient referred for VRT? 

Prior to starting VRT, a patient should be evaluated by a physician with specialized knowledge about concussion and brain injury. A concussion can cause a myriad of symptoms in addition to dizziness/imbalance, so a thorough and complete assessment of post-concussion symptoms is necessary to determine the correct course of treatment for each individual. Depending on the severity of the injury and the symptoms, an audiology evaluation may be helpful to more thoroughly assess inner ear function.  The physician overseeing the case usually determines which clinical tests need to be performed prior to initiating vestibular therapy.

9. What would you want the general public to know about concussion rehabilitation? 

Concussion rehabilitation is most effective and efficient when the patient receives a multidisciplinary evaluation and individualized approach to care. Concussion is a complex injury which should not be addressed using a “cookie cutter” approach to treatment and focusing on treatment of only one aspect of concussion may lead to a longer recovery.  

10. What is your overall key take home message for providers working with patients with suspected post-concussion dizziness? 

I would highly recommend that the provider working with post-concussion dizziness complete specialized training that addresses the nature of concussion/brain injury and reviews appropriate treatment protocols. I cannot stress enough the importance of having a multidisciplinary team of clinicians overseeing the treatment, management and rehabilitation of patients to ensure the patient is receiving the best care for his or her injury.   

 

Shelly Massingale is the senior director of Banner Concussion Services in Arizona and Colorado. She is a physical therapist and has been a specialist in vestibular and balance therapy for the past 22 years. Shelly has focused her treatment and research primarily in mild traumatic brain injury since 2013 and has lectured nationally and internationally on evaluation and treatment of vestibular and balance deficits related to mild traumatic brain injury. 

The Medicare Audiologist Access and Services Act

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) 

JAAA Editorial: The American Academy of Audiology Honors Committee: A Mechanism to Acknowledge Those in Audiology Who Have Gone Above and Beyond in Their Contribution to the Profession


Access JAAA online

Volume 30, Number 7,
July/August 2019

Patricia Gaffney, AuD  Chair, Academy Honors Committee
Devin L. McCaslin, PhD 
• Deputy Editor, Journal of the American Academy of Audiology

Read more