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Audiologist in Internal Med Office

  1. #1
    Location
    Grand Rapids, MI
    Posts
    17
    Question Audiologist in Internal Med Office
    Medical Coding Books
    I have an audiologist who wants to come to our internal medicine office to perform hearing tests on our patients (92557 and 92570). Two questions:

    1. Does an audiologist need a supervising physician? If so, can the supervising physician be Internal Medicine?

    2. This audiologist is employed by a different company, but for a charge of $100 per day she will perform the hearing tests on our patients in our office, and we can bill the charges. Does this violate STARK at all?


    Thanks so much!!!!
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

  2. #2
    Location
    Tuscaloosa, AL
    Posts
    92
    Default
    I cannot answer the Stark question, but effective Oct 2008 Medicare requires that audiologists bill for services they perform under their own NPI.
    Jerri, CPC

  3. #3
    Location
    Grand Rapids, MI
    Posts
    17
    Default
    Can you tell me where that information is?


    Also - Can anyone else answer the STARK part?
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

  4. #4
    Location
    Tuscaloosa, AL
    Posts
    92
    Default
    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

    Section 80.3 addresses the audiology services - begins page 97.

    Page 98, paragraph 3 states "not covered under the benefit for services incident to a physician's service because they have ther own benefit "as other diagnostic tests"."

    At this time Medicare and Medicare products are the only plans we have to worry about; your commercial carriers may make this a worth-while endevour.
    Jerri, CPC

  5. #5
    Location
    White Plains, NY
    Posts
    123
    Default
    Usually when I post as fraud investigator i am totally ignored, but I'll try this anyhow.

    If a plan sees an increase in audiology testing, there had better be a medically necessay reason.
    And every child that comes in with a URI and otitis media doesn't qualify.


    Lin Osborn
    CPC CFE

  6. #6
    Location
    Grand Rapids, MI
    Posts
    17
    Default
    Jerry - Thanks so much; that was really helpful. Unfortunately, the patient population my Dr is interested in doing the audiology testing on is almost all MCR.

    Lin - We are internal med...so no children. Since you're a fraud investigator - do you know if this arrangement would violate the Stark Law in any way?
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

  7. #7
    Location
    White Plains, NY
    Posts
    123
    Default
    Since I am not a lawyer, I cannot advise you regarding Stark. A lot of Stark is based on the fiduciary relationship between providers. You can just Google "new Stark provisions," and you'll get almost 8 million hits, but here is one: http://www.nixonpeabody.com/publicat...l3.asp?ID=3248

    If we were examining this, we would ask, "What is the fair market value for the services this audiologist is providing in your office," as well as the medical necessity for the services.

    What I was advising against was changing the number audiology tests your practice makes. A sudden leap in testing signals to us that the doctor got a machine, and since the machine spits out an electronic printout that can now be entered into the record, the practice thinks that is enough to justify performing the test. It is not, and could trigger an audit of the whole practice, not just your audiology claims.

    We would have additional issues with the audiology testing recorded in the medical record as being performed by someone who is not a trained audiologist (your internist). How would you treat a patient that showed profound hearing loss? We would hope you would send them to a specialist, who would repeat the testing. I have also seen the printouts where the name of the technician running the test is not credentialed by the insurer. Depending on the contract, that could also raise a red flag.

    Lin

  8. #8
    Location
    Grand Rapids, MI
    Posts
    17
    Default
    Thanks so much! That was really helpful.
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

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