Question
To bill for Medicare, audiologists must have a referral from a physician. Doesn't that mean that patients would be under the care of a physician prior to audiological testing (and therefore not eligible for audiology reporting of PQRI)?
Answer
Dr. Kim Cavitt: It depends on the situation. Oftentimes the referring physician is a primary care physician or an internist and the patient is being sent to the audiologist to determine what is going on with the patient. The patient may not be under the care of the physician for the condition they are presenting to the audiologist. It is not clear that every patient who has a physician's order has in fact seen the physician for the particular condition that they present to the audiologist.
Dr. Robert C. Fifer: I agree with Dr. Cavitt. One of the main premises of Medicare is active treatment. Many times patients are referred to audiologists by primary care physicians who are trying to determine what the problem is and therefore take the first step of referring to an audiologist;they have not been involved in active treatment of the condition. Although we are required to have the physician referral to bill Medicare, that in essence places audiologists as a quasi point of entry into the system. Once we as audiologists determine what is going on the onus falls on our shoulders to get that patient back into active treatment, with the operative word being active. If the physician is only involved on a peripheral or incidental basis in the referral, that does not necessarily count as active treatment.
Cavitt: Another example of when audiologists will be the first point of entry for Medicare beneficiaries is when we have an existing patient who comes to us before seeing any other healthcare provider. Let's use the example of an existing patient who returns to us because of an actively draining ear or a sudden hearing loss, before seeing any other physician or professional. We would then ask that patient to see his or her physician to obtain an order so that we can bill Medicare and conduct the necessary testing to determine what is going on. Then, if it is determined that there is indeed an issue that deems referral to the primary care physician, internist, otolaryngologist, etc. we will make that referral(s).
This Ask the Expert was taken from the recorded course, An Audiologist's Guide to the Physician's Quality Reporting Initiative (PQRI), course #15289. To view the recorded course, register here.
Kim Cavitt, Au.D. is the owner of her own Audiology consulting firm, Audiology Resources, Inc. Dr. Cavitt represents ADA on the Audiology Quality Consortium (AQC).
Robert C. Fifer, Ph.D. is Director of Audiology and Speech Language Pathology at the Mailman Center for Child Development at the University of Miami. Dr. Fifer represents ASHA on the Audiology Quality Consortium (AQC).
