March 2021 Audiology Resources Newsletter

Volume #27 - March 2021

Audiology Resources

Monthly News & Updates

As I approached the 20th anniversary of the founding of Audiology Resources, I felt like my logo and images needed a refresh!

I was talking with the amazing Kayla Wilkins, AuD at Aspire Hearing and Balance and she was showing off her new logo and branding. I immediately fell in love with the simplicity yet creativity her imagery invoked! I also loved that her designer was an audiologist. It is always wonderful to keep business "within the family".

I met with Phallon Doss, AuD and loved her approach to branding. She helps you work through your story and what best represents your business.

When I was presented this logo option, I immediately saw the beloved boot camp booklet! As a result, I loved the tie in and could not get past how I was drawn to the image. The booklet is the one thing I would love to ditch (to be paperless and environmentally friendly) but the also the one thing that attendees love and, as a result, I can never truly ditch! This image illustrates and will serve as a reminder that my client comes first! I thought this homage to the booklet, and the resources it provides, was a perfect, fitting image to represent my business in 2021 and beyond!

Thank you Dr. Doss and your design team! I am excited to embark on the next decade of Audiology Resources and where this will lead us!

Cheers!

Kim

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Audiology Resources and the 2021 Recorded Boot Camp and Upcoming Face to Face Training events

Monthly Coding and Reimbursement Tips

UHC Commercial Plan Hearing Aid Billing Guidance

United Healthcare (UHC) is being a stickler about the documentation required to receive coverage for a commercial hearing aid claim. These requirements exist because many audiology colleagues were billing for hearing aids before they were fit, fitting hearing aids on individuals who did not have hearing loss, sending inflated, false invoices with the claim, fitting older, stock hearing aids on UHC members, and perpetually upgrading the fitting, at significantly higher usual and customary rates, and not offering the UHC member an option within the benefit. Yet again, the actions of a few have complicated the process for many.

In order to attempt to secure UHC payment and meet the medical policy requirements, please be aware of the UHC Medical Policy on Hearing Aids.

I recommend that the following be submitted upon request for additional information (after the claim is initially submitted electronically):

A copy of the patient’s audiologic evaluation and communication and functional needs assessment and care plan/hearing aid examination and selection and care plan. This should document the make and model of hearing aid being recommended.
A copy of the “written recommendation for hearing aids” form (very specific form; not an FDA medical clearance) completed and signed by a physician (physician ONLY) dated after the evaluation and prior to the hearing aid fitting and completed within the last six months. I recommend that the form contain the make and model of hearing aid being recommended.
A signed copy of the FDA medical clearance or medical waiver.
A copy of the actual manufacturer invoice, complete with patient name and a date ordered after the evaluation (do not fit stock aids on insurance cases).
A signed copy of the state required bill of sale/hearing aid contract/hearing aid receipt/statement of sale.
If your state does not require this document, create a document that reflects date of fitting, items dispensed and their serial numbers (which line up to the invoice data) and pricing.
If the patient upgraded above the UHC benefit limits, a signed copy of an upgrade waiver.

Please do not fit hearing aids on a patient who does not have a documented peripheral hearing loss (i.e. for the sole purpose of tinnitus management) and make sure your ICD-10 diagnosis codes billed reflect a hearing loss.

Historical Journal Article Spotlight

I decided to go back and reread the pre-eminent articles (and their resulting discussion via Letters to the Editor which are available via a Google search of the initial article) as I have been pondering whether or not we, as a profession, have fulfilled the mission and intent of the AuD. I think these are important reads as we have to begin to consider the future for audiology.

Doctor or Dispenser? What is the True Identity of Audiology?

I follow a lot of audiology discussions on social media. I see audiologists fearful of and frustrated by a lack of unified leadership, student loan debt and the subsequent return on that investment, reduced consumer awareness of who we are and what we do, reimbursement and managed care woes, third-party middlemen, competition from big box retailers, and the fear of what lies ahead with greater over the counter/direct to consumer amplification options. I see a profession on the precipice of major tectonic shifts on numerous, simultaneous fronts. I also see an almost cult-like following of five manufacturing entities, who appear to have way more influence, in terms of human and financial resources, than is typically seen from other healthcare durable medical equipment suppliers or pharmaceutical companies.

I started wondering: How did audiology get HERE, to the situation we find ourselves in today? I think we need to look back a bit before we can chart a course forward. Audiologists have now been able to dispense amplification for over 40 years. Yet, our audiologic evaluation, pricing, and care delivery models are essentially unchanged. When audiologists first stepped into the dispensing role, they went from the itemized, care centric model of a non-dispensing audiologist to the bundled, product centric model of a hearing aid dispenser. We lost sight of what makes audiologists, audiologists. Evaluation started revolving around a decision between surgical intervention or amplification, with no other option afforded except for “come back if you notice a change”. Auditory rehabilitation was replaced by a product, which was communicated to consumers as a solution to everything. We, the audiologist, faded into the background. We started marketing free or discounted care and tied our professional and practice entities solely to the sale of a product. Many consumers and patients, as a result, see us no differently than they see a dispenser with a high school diploma or associate’s degree and minimal formal training.

The AuD degree, as the entry level degree into audiology, is now close to 25 years old. I have been reading (and have linked the articles for all of you above) the original articles and resulting discussions of the “AuD Wars” of the late 1980s and early 1990s. In reading these pieces, I must admit that the goal of the AuD movement is still unfulfilled. This initiative did not turn out as advertised. We never changed our educational or service delivery models and created a “doctoring” culture, yet we raised the price of entry into audiology significantly. Sometimes I feel as though we are asking students to buy a title, not a profession. We never socialized audiologists to behave as doctors and, as a result, many audiologists do not have a “doctoring” mentality. We do not look at or evaluate the whole patient, create care plans, or prescribe comprehensive treatment solutions. Masters’ programs transitioned, by name only, into AuD programs. Preceptorship and mentorship remained unchanged. And, we replaced a CFY supervised experience model with a poorer, more untenable externship process and system. Even 25 years after we made this change, we still cannot illustrate whether the outcomes warrant the cost of the change in degree. Care has not expanded and awareness has not increased.

Here is where the identity crisis begins to emerge. I see more audiologists fighting for hearing aid sales and delivery protections and against direct to consumer amplification options than I see fighting for changes to the AuD educational model, state scope of practice expansion or clarification, or the benefits afforded by the Medicare Audiology Access or Services Act. I see more audiologists attending manufacturer centric and sponsored “educational” events than their state or national professional association meetings. I see more practices focusing on hearing aid sales, despite the depth and breadth of their education and experience, rather than audiology practice.

We cannot get a foothold on increased audiology awareness and recognition if we continue to present ourselves, in words and actions, as anything more than a “doctor of audiology”. Respect is earned not given. We need to move past being “educated dispensers” or we need to stop asking the next generation to take on this often insurmountable debt. If we want the respect afforded to “doctors”, we need to behave like doctors all the time, every day.

Doctors:

Take their Hippocratic Oath seriously and put patient above product and profit.
Practice to the research evidence every day, with every patient.
Embrace, rather than fight, technological, medical and pharmaceutical advancements that benefit their patient.
Are life-long learners and innovators and continue to expand their knowledge base and/or scope to better meet the encompassing and ever changing needs of their patients.
Think for themselves.
Refer patients to other providers when it is in the best interest of the patient, even if that means they lose the individual as a patient.
Support access to care.
Bind together under a national leadership umbrella and representative body.
Invest time and treasure in advocacy initiatives at the state and national levels. They fight against outside threats, not each other.
Typically have interactions with durable medical equipment manufacturers reported to the government and publicly available via the Open Payments Act provisions. As a result, they have transparent, “arm’s length” relationships with vendors.
Mentor and precept the next generation of their profession.
Bind together into larger practice entities in an attempt to stay independent.
Do not negatively talk about their patients on social media and do not depend on social media as a professional resource. Their state and national associations serve as their professional resource.
See their discipline as a profession, not a sales channel or a club.

We need to determine, once and for all, who and what an audiologist is or can be and fully realize the AuD in actions and intent. The title of “doctor” is a mindset, not just a title on a piece of paper. Hard choices and tough decisions need to be made. Sacrifice, compromise and collaboration need to be the norm at every level of our profession and its interactions. The sands in the hourglass are slowly running out. We have to practice audiology and become the doctor we were intended to be or face being seen as expendable. My identity is “doctor of audiology”, what is yours?