Interview with Robert Fifer Ph.D., Director of Audiology and Speech Pathology, Mailman Center for Child Development
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TOPIC: Coding, Billing and Reimbursement.
AO/Beck: Hi Dr. Fifer, thanks for taking the time to speak with me today.
Fifer: Sure Dr. Beck, happy to participate.
AO/Beck: Dr. Fifer, can you please tell me about your professional background?
Fifer: I got my Ph.D. from Baylor College in 1985, and Dr. Jerger was the chair of my dissertation committee. My dissertation was on MLR and Steady State Evoked Potentials (SSEP) in neonates. At that time, the 40 Hz potential was just coming out in adults, and we started to examine it in babies through my dissertation in order to ascertain what their predominant frequency is, and it turned out to be 28 Hz.
AO/Beck: How did you develop your expertise regarding coding, billing and reimbursement?
Fifer: It's a long story! But in brief, in 1994-1995, during his AAA presidency, Dr. Robert Keith called me and asked if I would represent AAA with ASHA for a presentation of new CPT codes to the AMA editorial panel. The meeting was going to be held in Miami, so it was a matter of convenience that helped initiate the call at that time, as I was local. Anyway, we were successful, and we had a small batch of codes that were approved, and were added to the 1996 CPT Manual. After that year of service with AAA had ended, ASHA asked me if I would serve with them for their CPT Task Force within ASHA, and except for a one year hiatus, I've been involved with coding ever since.
AO/Beck: That really is very valuable knowledge, and I think it's great that you've worked with AAA and ASHA on this. Very few people have in-depth knowledge on these topics, and I think we all wonder about these issues on a regular basis.
Fifer: Yes, I think that's correct. However billing and reimbursement was an issue the profession hadn't paid much attention to until 5 or 6 years ago. In part, the reason for that was the emphasis on private practice, and the emphasis within private practice on hearing instrument dispensing. As we have evolved the profession into a diagnostic based practice, as well as cochlear implant rehabilitation and universal newborn hearing screenings, and many other professional areas of practice, we've seen the need to understand billing and coding for many reasons, and most of them are obvious. In general, regarding billing and coding we're somewhat behind the curve on this as a profession, and we've had to play catch-up.
AO/Beck: For people who need to get up to speed on these topics, what are the best sources of information for this topic?
Fifer: There are some really important guidelines and every audiologist should have them in their office, as do the physicians. For example, an updated CPT manual is very important. The manual is published annually by the AMA, and the new one comes out in November for the new codes that are to go into effect the first of the year. In addition, the audiologist should have the ICD-9 CM book for the entire listing of diagnoses. Both can be purchased through the AMA website, and they can probably also be ordered through the major bookstores like Barnes and Noble, as well as most medical school book stores.
AO/Beck: What about AAA and ASHA? Do they have information available through their websites?
Fifer: Yes they do, and in particular they both have CMS (Medicare and Medicaid) information online, and as the information changes, AAA and ASHA have been very good at updating their websites, so it is important to monitor and review those sites from time to time to stay on top of the changes. Of course, I must say that Audiology Online has been excellent at keeping the professionals informed too. For the reader unfamiliar with CMS, they can view those news releases on your site too.
AO/Beck: Of course another source would be articles and the ask-the-expert (ATEs) which you've published on Audiology Online, and those too, are just a click away. I will insert some of the hyperlinks below, for easy access by the readers.
Fifer: Additionally, Medicare publishes it's own rules within the Department of Health and Human Services (www.hhs.gov) and on their home page, you'll find their directory, which will take you to the Centers for Medicare and Medicaid.
AO/Beck: Has billing and reimbursement changed under CMS?
Fifer: Not in particular. There have been some updated policies that have come forth through Medicare, but the changes were not due to the restructuring and re-organization of CMS. However, the single most important change that has occurred was the recent update which stated that a diagnosis of sensorineural hearing loss does not prohibit reimbursement for audiologists.
AO/Beck: Yes, I agree, that was an extremely important step, and one that was frankly, long overdue! Has there been any recent or new activity or action on the proposal from the congressman in Florida regarding Medicare paying for hearing aids?
Fifer: No, that has pretty much withered up and died. I haven't really heard anything about that in quite some time, but I don't anticipate it'll be going anywhere soon. There probably will be some future activities related to this, but obviously since 9-11, most of the federal efforts have been addressing security and terrorism. The bottom line here is of course money. Two topics that are pressing and that will have to be addressed are prescription drugs and hearing aids, but again, I don't think there will be any significant changes in the short term. The entire professional health care community and virtually all of the citizens and recipients of these systems are demanding better and higher quality health care and better access to health care, but again it boils down to money - nobody wants to pay for it!
AO/Beck: Any changes recently in federal funding for research?
Fifer: Yes, I'm glad you asked that. NIH has recently substantially increased the available funding for medical and health research. This year there was a significant funding increase, and next year there is another increase schedule. What is lacking is outcomes research, and that is slowly occurring thanks in some respects to some initiatives from our Speech-Language Pathology group in Florida, which has worked with ASHA, and ASHA is now pushing that forward.
AO/Beck: Bob, what can you tell me about the relationship between the AMA and the non-physician hearing healthcare professionals? Is there a healthy relationship, or is it more an antagonistic situation?
Fifer: In general it is a healthy relationship, and I actually think it is improving over time. Much of our relationship with the AMA is through the AAO-HNS, and the key people at AAO-HNS have worked with us to manage and improve the protocols.
AO/Beck: Very good Bob. I thank you again for your expertise and your time and I'm glad you're on top of these things!
Fifer: My pleasure Doug.
RECOMMENDED HYPERLINKS RELATED TO THE FIFER INTERIVIEW:
Reimbursement for Professional Services
HCFA Reorganizes Under New Name 8-8-2001
CPT Codes & Billing for Tinnitus Maskers
HHS Fact Sheet: THE NEW CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
AO/Beck: Hi Dr. Fifer, thanks for taking the time to speak with me today.
Fifer: Sure Dr. Beck, happy to participate.
AO/Beck: Dr. Fifer, can you please tell me about your professional background?
Fifer: I got my Ph.D. from Baylor College in 1985, and Dr. Jerger was the chair of my dissertation committee. My dissertation was on MLR and Steady State Evoked Potentials (SSEP) in neonates. At that time, the 40 Hz potential was just coming out in adults, and we started to examine it in babies through my dissertation in order to ascertain what their predominant frequency is, and it turned out to be 28 Hz.
AO/Beck: How did you develop your expertise regarding coding, billing and reimbursement?
Fifer: It's a long story! But in brief, in 1994-1995, during his AAA presidency, Dr. Robert Keith called me and asked if I would represent AAA with ASHA for a presentation of new CPT codes to the AMA editorial panel. The meeting was going to be held in Miami, so it was a matter of convenience that helped initiate the call at that time, as I was local. Anyway, we were successful, and we had a small batch of codes that were approved, and were added to the 1996 CPT Manual. After that year of service with AAA had ended, ASHA asked me if I would serve with them for their CPT Task Force within ASHA, and except for a one year hiatus, I've been involved with coding ever since.
AO/Beck: That really is very valuable knowledge, and I think it's great that you've worked with AAA and ASHA on this. Very few people have in-depth knowledge on these topics, and I think we all wonder about these issues on a regular basis.
Fifer: Yes, I think that's correct. However billing and reimbursement was an issue the profession hadn't paid much attention to until 5 or 6 years ago. In part, the reason for that was the emphasis on private practice, and the emphasis within private practice on hearing instrument dispensing. As we have evolved the profession into a diagnostic based practice, as well as cochlear implant rehabilitation and universal newborn hearing screenings, and many other professional areas of practice, we've seen the need to understand billing and coding for many reasons, and most of them are obvious. In general, regarding billing and coding we're somewhat behind the curve on this as a profession, and we've had to play catch-up.
AO/Beck: For people who need to get up to speed on these topics, what are the best sources of information for this topic?
Fifer: There are some really important guidelines and every audiologist should have them in their office, as do the physicians. For example, an updated CPT manual is very important. The manual is published annually by the AMA, and the new one comes out in November for the new codes that are to go into effect the first of the year. In addition, the audiologist should have the ICD-9 CM book for the entire listing of diagnoses. Both can be purchased through the AMA website, and they can probably also be ordered through the major bookstores like Barnes and Noble, as well as most medical school book stores.
AO/Beck: What about AAA and ASHA? Do they have information available through their websites?
Fifer: Yes they do, and in particular they both have CMS (Medicare and Medicaid) information online, and as the information changes, AAA and ASHA have been very good at updating their websites, so it is important to monitor and review those sites from time to time to stay on top of the changes. Of course, I must say that Audiology Online has been excellent at keeping the professionals informed too. For the reader unfamiliar with CMS, they can view those news releases on your site too.
AO/Beck: Of course another source would be articles and the ask-the-expert (ATEs) which you've published on Audiology Online, and those too, are just a click away. I will insert some of the hyperlinks below, for easy access by the readers.
Fifer: Additionally, Medicare publishes it's own rules within the Department of Health and Human Services (www.hhs.gov) and on their home page, you'll find their directory, which will take you to the Centers for Medicare and Medicaid.
AO/Beck: Has billing and reimbursement changed under CMS?
Fifer: Not in particular. There have been some updated policies that have come forth through Medicare, but the changes were not due to the restructuring and re-organization of CMS. However, the single most important change that has occurred was the recent update which stated that a diagnosis of sensorineural hearing loss does not prohibit reimbursement for audiologists.
AO/Beck: Yes, I agree, that was an extremely important step, and one that was frankly, long overdue! Has there been any recent or new activity or action on the proposal from the congressman in Florida regarding Medicare paying for hearing aids?
Fifer: No, that has pretty much withered up and died. I haven't really heard anything about that in quite some time, but I don't anticipate it'll be going anywhere soon. There probably will be some future activities related to this, but obviously since 9-11, most of the federal efforts have been addressing security and terrorism. The bottom line here is of course money. Two topics that are pressing and that will have to be addressed are prescription drugs and hearing aids, but again, I don't think there will be any significant changes in the short term. The entire professional health care community and virtually all of the citizens and recipients of these systems are demanding better and higher quality health care and better access to health care, but again it boils down to money - nobody wants to pay for it!
AO/Beck: Any changes recently in federal funding for research?
Fifer: Yes, I'm glad you asked that. NIH has recently substantially increased the available funding for medical and health research. This year there was a significant funding increase, and next year there is another increase schedule. What is lacking is outcomes research, and that is slowly occurring thanks in some respects to some initiatives from our Speech-Language Pathology group in Florida, which has worked with ASHA, and ASHA is now pushing that forward.
AO/Beck: Bob, what can you tell me about the relationship between the AMA and the non-physician hearing healthcare professionals? Is there a healthy relationship, or is it more an antagonistic situation?
Fifer: In general it is a healthy relationship, and I actually think it is improving over time. Much of our relationship with the AMA is through the AAO-HNS, and the key people at AAO-HNS have worked with us to manage and improve the protocols.
AO/Beck: Very good Bob. I thank you again for your expertise and your time and I'm glad you're on top of these things!
Fifer: My pleasure Doug.
RECOMMENDED HYPERLINKS RELATED TO THE FIFER INTERIVIEW:
Reimbursement for Professional Services
HCFA Reorganizes Under New Name 8-8-2001
CPT Codes & Billing for Tinnitus Maskers
HHS Fact Sheet: THE NEW CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
Robert C. Fifer, PhD
Director of Audiology and Speech Language Pathology at the Mailman Center for Child Development at the University of Miami
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 AQC.