Question
Why is it that the New York State Medicaid Department will not cover the cost of ENG testing as performed by a licensed and certified audiologist? Medicaid is usually the secondary payer anyway for many of our ENG Medicare patients.
Answer
Well, the only thing consistent about Medicaid from state to state is that there is nothing consistent about Medicaid from state to state. The state legislature and the state Medicaid Office has tremendous input as to what services they will cover and also how they will cover them.
Now, there's another little twist thrown into this question when the Medicaid patients are also Medicare eligible. As a licensed audiologist Medicare provider, Medicare should reimburse you based upon what you did and the fact that you are a qualified healthcare provider in the Medicare System. Medicaid, however, does not have to recognize you for every procedure, and in most states audiologists are not recognized for every procedure. It's sort of a cafeteria mode in that some states recognize audiologists for some things, not for others and what audiologists are recognized for will vary from state to state. It comes down to a matter of the state Medicaid Office and your legislature both have a lot of say as to what's covered and what is not, and that's the reason why you may not be recognized for a procedure by the state Medicaid Office even though you should be by federal Medicare.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
