Coding and Billing: What Students and Universities Need to Know

May 25, 2017 | Audigy University, Coding & Billing

For years, there have been persistent questions about the requirements of supervision for students in their fourth-year clinical assignments regarding coding, billing, and Medicare. Audigy University’s frequently asked questions cut through the confusion on this and other Medicare issues, offering quick, helpful answers for students, universities, and preceptors.

Q. What are the Medicare requirements for students?
A. Medicare requires 100 percent line-of-sight supervision by the preceptor of the student’s diagnostic clinical processes, including testing and report writing. The supervisor is to be engaged entirely in what the student is doing and is not to be distracted with report writing or other activities. The student and the supervisor are to write the report to the referring provider together, and both may sign it. The supervisor bills Medicare for these services as they were intricately involved with the student from greeting the patient to offering recommendations for their care.

Q. Are there other requirements for Medicare?
A. Yes, there are two for all audiologic diagnostic services. Because of audiology’s category status of “other diagnostic tests” within Medicare, enrolled audiologists are recognized for payment only for diagnostic services. While Medicare does recognize audiologists provide other services that are in our scope of practice, such as cerumen removal when performed by an audiologist or for treatment, Medicare won’t reimburse for these; therefore, they can be the patient’s personal responsibility to pay. Any of the providers below, as allowed by their state licensure laws, can issue the required order prior to or at the time of the audiologic assessment. The second requirement of medical necessity must also be met to bill diagnostic services to Medicare. The providers Medicare recognizes for ordering/referring are listed below, but they must be enrolled in the Provider Enrollment Chain and Ownership System (PECOS). Their enrollment must be verified as the claim will be denied if they are not enrolled, even if that provider has chosen to opt out of Medicare.

  • Physician (Doctor of Medicine or Osteopathy, Doctor of Dental Medicine, Doctor of Dental Surgery, Doctor of Podiatric Medicine, Doctor of Optometry)
  • Physician Assistant
  • Certified Clinical Nurse Specialist
  • Nurse Practitioner
  • Certified Clinical Nurse Specialist
  • Nurse Practitioner
  • Clinical Psychologist
  • Certified Nurse Midwife
  • Clinical Social Worker
  • Interns, residents, and fellows

Q. How are the services of an audiologist to be billed to Medicare?
A. Audiology services are to be filed with the National Provider Identifier (NPI) of the audiologist, regardless of whether they are employed by a physician or are an independent private-practice audiologist, and the benefits paid can be assigned to the physician or the practice with the filing of an 855R, reassignment of benefits. If employed in a hospital, the hospital bills all services performed by all providers under the hospital’s NPI.

Q. Can audiologists opt out of Medicare?
A. Audiologists are not one of the professionals who can opt out of Medicare. If one chooses not to enroll in Medicare, that provider is required to furnish all diagnostic services at no charge to all patients, regardless of whether they are private pay or insured.

If you have any questions, please contact Deb Abel, Au.D., at [email protected].