I know that the patient is responsible for getting the physician’s order for a hearing test under Medicare, and that we can’t request it of the physician or it is considered solicitation. Can you explain what is meant by solicitation?
Answer
Here is a link to a great piece on the Anti-Kickback statute as well as a great article from the Hearing Journal. In a nutshell, this is how the Medicare system is suppose to function:
The patient reports to a physician that they are having difficulties with hearing or balance. The physician orders a hearing test from an audiologist.
The patient contacts your office. You indicate, to the patient, that if they need a physician order for Medicare coverage that it is their responsibility to obtain the needed order. The patient needs to understand that they will be responsible for the testing if they do not secure a physician order or if the test is for the sole purpose of getting a hearing aid (not medically necessary).
The mere existence of a physician order does not guarantee medical necessity. Medical necessity is determined by the case history.
I hope this is helpful. If you have further questions, please refer to the billing and coding resources provided by the audiology professional associations (AAA, ASHA, and ADA).
Kim Cavitt, AuD
Kim Cavitt, AuD was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, 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 currently serves on the Board of the Academy of Doctors of Audiology and the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.
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