Audiology Resources
Monthly News & Updates
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It is finally warm and dry enough here in Chicago to call it summer! Yay! I hope that, wherever you are, you are seeing sunshine and experiencing fun and relaxation with your family and friends.
This summer I have done a lot of waiting for my daughter (I am experiencing my own mother's karma). As a result, I have been able to be a more active participant in social media. I see many questions around compliance, coding, managed care, reimbursement, and pricing and delivery models that could be answered and problems that could be addressed through education. Many of the answers provided are incorrect or incomplete. Getting the correct answers, rather than the free or expedient ones can, literally, affect your bottom line and impact your own compliance.
Reach out to the national associations you are a member of for answers. If they cannot or will not answer your questions, join an association who can and will.
ADA or Michigan Audiology Coalition members, for example, can reach out me and I will address their questions, at no charge, as part of their membership benefits (which is why I cannot answer questions at no charge).
Audiology Resources Boot Camp attendees can get up to one year of no charge guidance after the event and, if you attend a face to face or live stream event, ask questions in real-time.
Please never stop learning, not just because you need CEUs, but because KNOWLEDGE IS POWER!
Cheers!
Kim
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Monthly Coding and Reimbursement Tips
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Allowable Rates
Allowable rates are the rates each individual insurance company allows you to collect, from them or the patient, for each specific insurance plan, benefit, or product and for each item or procedure provided to the patient. Some insurance companies may have multiple allowable schedules (PPO, POS, HMO, Medicare Advantage, Medicaid).
Some payers, like Medicare and Medicaid, post their allowable rates on their websites. Other insurance companies, like UHC and some BCBS plans, provide access to their allowable schedules through their online portals. Most though are only available though written inquiry with the insurer (which is HARD to do after contracting; reach out to the contracting department via email) or though collecting data through your explanation of benefits. PLEASE do not sign a managed care agreement without FIRST requesting and reviewing the allowable rate schedules, for every insurance product they offer and for every service you provide. Compare this to your breakeven plus profit amount to determine if participation is a good business decision.
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Research Spotlight
I am going to take a different route this month. I think it is important for audiologists to be aware of the NIH/NIDCD funded projects that are exploring accessible and affordable delivery of hearing health care. Peruse these studies. Review their data. It will give you an excellent snapshot in disruptive care and delivery and the science behind it.
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The Over the Counter (OTC) Hearing Aid Act (
https://www.congress.gov/bill/115th-congress/senate-bill/670/text
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was signed into law in August, 2017. The law stated that the Health and Human Services (HHS) and the Food and Drug Administration (FDA) had three years from the date of passage to create proposed regulations, which will operationalize and implement the provisions of the bill. These proposed regulations must include a public comment period and HHS and the FDA have 180 after the close of that comment period to issue final regulations. It is estimated that the proposed regulations will be issued in November 2019.
Amy question is: Are you and your practice prepared for OTC implementation?
- How are you going to address consumer and existing patient questions? Local media inquiries?
- Do you have a plan on how you are going to handle audiometric testing? For those of you currently providing this at no charge, will you change your model?
- How will you handle the hearing aid examination and selection/communication needs assessment, especially for individuals who have no intent on purchasing amplification from you? Will those of you who are not already truly unbundled begin charging for this service?
- Will you provide patients with copies of their testing and the results of their communication needs assessment?
- Will you be willing to provide the care they are not able to get over the counter (fitting and orientation, electroacoustic analysis, verification, service, aural rehabilitation and counseling)? How will you monetize that?
- Will you stock OTCs?
- Are you prepared to address your employee compensation structures and models?
- Will any of the Big 5 get into this market? How will you react if they do?
- How will this affect buying groups and third-party administrators/provider networks and their offerings? Is it positive or negative for them?
- Are all of you prepared to get personally involved at the state level, with your state audiology association, to address the changes that will have to happen at the state level (because the OTC bill provisions supersede state hearing aid dispensing laws)? These organizations will need your time and membership dollars! Are you prepared?
Whether we remain bundled or not, each of us will need to have a plan of how they we are going to handle these consumers and patients. There will be A LOT of press coverage. There will be positive and negative stories about audiology as part of that. But our response to this press and our individual PLANS for our practices are key to setting the tone and setting the stage. I fear if we go “negative” and say “no”, we run the risk of painting our profession as out of touch and greedy and alienating an entirely new market of consumers.
I hope, instead, we go “honest”! I hope we talk about the advantages and limitations of self-assessment and OTC products using research and facts, not fear or a yet to be required desire for self-preservation. THIS could grow the entire market. THIS could greatly increase awareness of audiology in ways we only imagined. Let’s show them who we are and what we can bring to the process and their overall health and quality of life. Let’s help individuals hear more and fall less, even if they are doing it with products we did not dispense. OTC will not suffice for everyone forever. Let’s be there when they need us. Let’s BE AUDIOLOGY! #thinkaudiology
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