More cumbersome, she said, is enrollment as a Medicare provider. In particular, she emphasized sections within two Medicare application forms that audiologists need to pay particular attention to for proper billing-Section 2 of the 855I form, which needs to be completed for each practice location where an audiologist performs services to Medicare patients, and Section 4 of the 855R, which must be completed for each practice or employer with which the audiologist contracts. This latter section is particularly important to correctly identify where Medicare should send payment for services.
Explore This IssueNovember 2008
Unlike obtaining an NPI, which could take only a few days, obtaining a Medicare number can take up to several months, said Ms. Vanderbilt. Even if an audiologist has an NPI, they may not have a Medicare number for months, and both are absolutely essential to receive payment.
This means that audiologists who have not yet received a Medicare number should hold their claims for filing their services until that number is assigned to them.
There is no doubt that holding the submission of claims will have a negative impact on the physicians’ cash flow, she said. However, CMS will backdate the effective date of the number so that those services can be billed retroactively.
Other Modifications to Audiology Billing
One of the issues discussed during the seminar was the modification that limits the use of technicians to perform audiology services. Under the new regulation, otolaryngologists must actively participate during any audiology test given by a technician to a Medicare patient for reimbursement of services by CMS. This generally means that an otolaryngologist must be in the same room as the technician while the exam is taking place.
According to James Denneny III, MD, an otolaryngologist in private practice in Knoxville, TN, and the immediate past president of the AAO-HNS, who moderated the miniseminar, this modification in the use of technicians has many people worried.
This has the potential to significantly restrict access in smaller towns because of the shortage of audiologists, he said.
Linda Ayers, echoing the sentiments of Dr. Denneny and all the presenters during the miniseminar, emphasized that access is the fundamental issue that has otolaryngologists concerned.
If physicians who use technicians are required to be actively involved in participation of service, meaning that they are in the room with the technician, they can’t be seeing other patients-and a physician has only so many hours in a day, she said. So particularly in rural areas where they [otolaryngologists] cannot hire an audiologist and they rely on technicians, this is going to be a major access issue.