Often Posed Questions (and Answers) Regarding Medicare, Contracting, and Non-Hearing Aid Services

Abstract

Medicare Part B provider participation is often met with grumbling and disdain by most health care providers, including audiologists. Other pain points for audiologists likely include insurance contracts, third-party administrators, and the unknown of the future. The dynamic landscape that will include technology and delivery systems was, until recently, mere thoughts on paper and in conference rooms. With the moderate amount of misunderstanding about Medicare and contracting rules among the members of the profession, it is this article's intent to dispel these Medicare myths as they pertain to hearing and balance services provided by Medicare Part B–enrolled audiologists, to offer considerations in a practice's decision whether to accept commercial insurance and third-party payer contracts, and to offer the tools to position a practice to provide non-hearing aid–related services based on today's current information.

Keywords

Medicare requirements - Medicare advantage plans - third-party administrators - vestibular and tinnitus services

• Suggested Reading

• 1 Centers for Medicare and Medicaid Services. Advanced Beneficiary Notice. 2019 . Available at: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html . Accessed March 21, 2019
• 2 Centers for Medicare and Medicaid Services. Audiology Services. 2019 . Available at: https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/PhysicianFeeSched/audiology.html . Accessed March 18, 2019
• 3 Centers for Medicare and Medicaid Services. Medicare Benefits Policy Manual, Chapter 15. 2019 . Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf . Accessed March 16, 2019
• 4 Centers for Medicare and Medicaid Services. Medicare Local Coverage Determination Policies. 2019 . Available at: https://www.cms.gov/medicare-coverage-database/indexes/lcd-state-index.aspx . Accessed March 15, 2019
• 5 Centers for Medicare and Medicaid Services. Medicare MLN 5717. 2019 . Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5717.pdf . Accessed March 16, 2019
• 6 Centers for Medicare and Medicaid Services. Medicare Administrative Contractors. 2019 . Available at: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html#MapsandLists . Accessed March 15, 2019