Question
I spend a great deal of my clinical day in rehabilitation. Come to think of it, every day I spend more time doing rehab than anything else, but I cannot collect reimbursement from Medicare for this time spent. From a reimbursement standpoint, is there any hope of getting ourselves recognized as more than diagnosticians of auditory impairment?
Answer
(Dr. Kim Cavitt) It's true that from licensure and scope-of-practice standpoints, we are recognized for more than our diagnostic abilities. It is only from a Medicare reimbursement perspective, not necessarily other third-party payors, that we are not considered as aural rehabilitators providing therapy services. As of right now, you have the right to charge and collect payment for the rehabilitative services you provide. This is an area where you can collect payment privately from Medicare beneficiary for those services. There are many audiologists who choose to pay for these services by bundling the rehab costs in with the hearing aid price. Even though Medicare does not recognize our rehabilitative efforts as reimbursable, you have the right to collect payment for these much-needed services in other ways.
The whole purpose of new legislation put forth by ASHA is to grant access to rehabilitation services provided by audiologists for more Medicare beneficiaries. If there are audiologists that do not want to be providers to Medicare beneficiaries, it is important to have the option to opt-out. This would allow you to see Medicare beneficiaries and charge them your rate and not get reimbursed at the Medicare rate. In the ASHA proposed legislation, opting out is a key component so that audiologists who do not want to be Medicare providers will have that option available.
(Dr. Steven White) The typical Medicare beneficiary would avail himself to auditory rehabilitation if it was a covered service, and the ability for Medicare beneficiaries to have a better quality of life would be improved greatly. Any Medicare beneficiary who has paid into the Medicare trust fund for most of their working life wants to get a return on that investment. Part of that would be to seek assistance from the best professional to provide that service, and audiologists can provide the best aural rehabilitation services available.
Editor's Note: This Ask the Expert was taken from the live e-seminar The Potential Risks Versus the Need for a Comprehensive Medicare Benefit recorded 6/16/2011. To access the complete course, please go here. www.audiologyonline.com/ceus/recordedcoursedetails.asp?class_id=18818.
Kim Cavitt, Au.D. spent nine years as a clinical audiologist and preceptor at both The Ohio State University and Northwestern University and spent two years as the Director of Professional Relations at HearPO. For the past ten years, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. Audiology Resources, Inc. provides comprehensive operational and reimbursement consulting services to hearing healthcare clinics, providers, organizations, buying groups, and manufacturers who want to be better equipped to compete in the managed care and healthcare arenas. She also currently serves on committees through ADA, AAA and ASHA and is an Adjunct Lecturer at Northwestern University.
Steven C. White, Ph.D., CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA, and has spent thirty years in government relations at ASHA. White, an ASHA Fellow, is ex officio of the Health Care Economics Committee and staff liaison to the Current Procedural Terminology Editorial Panel and the Relative Value Update Committee. He is co-author of Health Plan Coding and Claims Guide, Negotiating Health Care Contracts and Calculating Fees, Appealing Health Plan Denials, Medicare Handbook for Audiologists and Medicare Handbook for Speech-Language Pathologists. He holds a M.S. in speech-language pathology and audiology from Ithaca College and a Ph.D. in audiology from Wayne State University.
