Audiology Resources
Monthly News & Updates
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I am happy to announce that I FINALLY have scheduled two 2021 Audiology Resources training events!
The first, for the fifth year in a row, is our Live Stream Boot Camp. You can participate LIVE, in real time, and ask questions as you go. We started providing socially distanced education before it was "trendy" (and necessary in a pandemic). The event will be held February 11 and 12, 2021.
Last summer, I had scheduled a two day Revenue Cycle (Scheduling through Payment) training event. COVID forced its cancellation but we plan to bring it back in 2021. The face to face event is scheduled for July 12 and 13, 2021 in Chicago/Rosemont, IL. Flexibility and fairness are important to me. As a result, attendees can cancel, with a full refund, up to 11 days before the event and, if the event is cancelled or modified in any way, you will also be eligible for a full refund.
Please stayed tuned for some additional training offerings in 2021! From your feedback, I am considering another live training series (a series of short, one hour live events) as well as an event tied to the Academy of Doctors of Audiology meeting in Portland, OR next fall.
Finally, now that my events are scheduled, I will be doing the drawing from my survey respondents, so stay tuned!
Stay Healthy! Cheers!
Kim
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Monthly Coding and Reimbursement Tips
Evaluation and Management Coding in Audiology
The American Medical Association (AMA) states that Evaluation and Management (E/M) codes can be utilized by “qualified health professionals who are authorized to perform such services within the scope of their practice.”
The first step in determining Evaluation and Management code use is determining if "evaluation and management" are in your state defined scope of practice. Just because it is NOT mentioned does not mean it is allowed. It will be important to have a written determination of scope (when not clearly delineated) from your licensure board to use in managed care appeals when they assign the financial responsibility to the provider rather than allow it to be assigned to the patient.
If you bill one patient is one clinical situation for an E/M code, you must bill every patient, regardless of age or payer, for an E/M code for that same clinical situation. In other words, you should not ONLY bill patients whose payers cover the code family and not bill others who do not. The billing needs to be consistent across all of your patients.
Third-party coverage of this code family is limited when provided by audiologists. Medicare and United Healthcare will not cover this code family if provided by an audiologist.
If you want to be reimbursed for this code, please consult each of your contracted payers for guidance. This code family is slated to change in 2021 so guidance you receive in 2020 may not be 100% applicable in 2021.
To learn more about E/M coding in audiology, please consider one of the boot camp offerings outlined above or pose questions to national or state associations where you are a member.
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Journal Spotlight
As teleaudiology and the remote delivery of care become more necessary, it is important to examine the data surrounding online or remote care.
Husmita Ratanjee-Vanmali and De Wet Swanepoel, and Ariane Laplante-Lévesque have some enlightening work on online evaluation and management of hearing loss.
These works are important for audiologists to read as we expand and explore new delivery models and methodologies.
This work was also highlighted in a series of articles in the
Hearing Journal:
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Tackling the Biggest Challenges Facing Audiology and Its Future One Month at a Time:
Medicare and Third-party, including TPA/N, Policies and Reimbursement
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In my August 2020 newsletter, I posed this poll question: In your opinion, what is the biggest challenge facing Audiology and its future? The largest response selected (almost 30%) was “Medicare and Third-Party, including TPA/N, policies and reimbursement. You can view the poll results HERE.
So, beginning this month and for the following nine months, I want to discuss each of these challenges individually and discuss some potential ways we can individually and collectively “tackle” these issues head on. I did something like this in a blog series in 2017 (Solving Audiology Issues Through Action) but this time I want to try to break this down by the specific “challenge” rather than a larger, global “issue”.
I both like and hate that managed care is still everyone’s biggest challenge. I like it because it is something I am very familiar with and, while I cannot solve every issue or will managed care and third-party administrators and networks (TPA/N) away, I can provide some potential solutions to ease the pain of participation. This is also why I hate it: Many options and solutions to exist if audiologists and audiology practices would evolve to meet the changing managed care landscape and invest time and treasure in learning to compete in the insurance game.
First, I want to acknowledge that this IS a challenge in audiology and that your concerns are valid and warranted. Managed care entities, insurance companies, and TPA/Ns do not make anything easy. They WANT it to be hard and they want many of you to give up during the process so that they do not have to pay you anything. Managed care is a healthcare version of the game Risk: strategic, conflict driven, and full of compromises and diplomacy. YOU, individually, just need to learn the game and how to play it to your benefit and for the benefit of those you serve. Will you always win? No. But there are tools so you can have more wins than loses.
Let’s discuss a few realities of managed care participation for audiologists:
- Audiologists cannot opt out of Medicare and enter into private payment arrangements with Medicare beneficiaries.
- Medicare and many other managed care entities do not recognize or allow coverage for an audiologist’s entire scope of practice.
- If you participate in any form of managed care and if you charge one individual for an item or service you must charge every individual you see, who receives the same item or service, and charge them the same fee, regardless of their age or payer. You cannot just charge those that pay and no charge those that do not.
- Managed care participation does not equal private pay, usual and customary rates for any healthcare provider in any medical discipline. If you want to participate you have to accept a discounted rate and realize that this discounted, allowable rate constitutes payment in full. If you want your full, usual and customary rates, remain out of network (except for Medicare, because you cannot opt out).
- Other than Medicare, you are a voluntary participant in managed care. No one is forcing you to be in-network.
Ok, now that we know a bit more about the landscape, need to consider what we, both individually and collectively, can and should do to better “manage” managed care. Here are some potential actions audiologists could take to try to move the needle:
- Change your pricing, care and delivery models and scope.
- A 1960s pricing and care model is no longer viable or relevant in a managed care, patient centered world.
- Support the Medicare Audiologist Access and Services Act (MAASA) through donating time and treasure. This bill’s passage would change our status within the Medicare system, allow for direct access (no physician order requirement) for audiologic and vestibular services, and allow for coverage of audiologic and vestibular treatment and rehabilitation.
- A Washington DC lobbying firm costs $150K to $200K each year. You do not pay enough in membership dues or convention attendance to fund these activities.
- There are approximately 15K audiologists in the US. Imagine if at least half wrote to or scheduled a meeting with their congressperson or gave $100 a year for advocacy (we would have $750K)!
- Support a single, national audiology association to represent ALL audiologists and their professional interests.
- Dentistry, optometry, speech-language pathology, physical therapy, and occupational therapy all have one large organization that represents their interests. We have two to three as a profession that is 5-10% of the size of physical therapy. This is ridiculous.
- Support your state audiology association by joining the association and attending their conference.
- Typically, the first line of defense against managed care, other than traditional Medicare, is at the state level. Managed care is regulated individually in each state and territory.
- This is where is it easier to launch a legal fight against unfair or fraudulent activities.
- Read contracts, ask questions and negotiate before signing any managed care agreement.
- Ignorance is not an excuse or a defense.
- Do not continue participating in managed care and third-party administrator plans which are not financially viable for your practice.
- Know your financial needs and do not participate if you cannot meet them.
- Merge your practices together to form a larger practice.
- Per the American Medical Association, approximately 15% of physicians are in solo practice, with another 15% working in practices with 50 or more physicians.
- There is strength in numbers, especially in managed care arenas.
- Bind together and form a class action lawsuit.
- Associations cannot sue insurance companies for fraud or illegalities. Providers or consumers have to bind together to tackle these situations.
- STOP thinking it is someone else’s responsibility to engage and fight.
- It takes an open mind, a modest financial investment, and a willingness to do some heavy lifting yourself to exact change.
To quote Barack Obama, “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek”.
What are YOU willing to tackle or sacrifice for long-term gains?
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