Audiology in Brief Wal-Mart has notified Blue Cross Blue Shield plans in four states-Alabama, Arkansas, California, and Illinois-that reimbursement claims submitted on behalf of their employees by independently practicing audiologists are not to be routinely denied. In addition, claims that were denied previously now will be reconsidered. Last fall ASHA alerted Wal-Mart ... News in Brief
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News in Brief  |   April 01, 2005
Audiology in Brief
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Hearing Disorders / News in Brief
News in Brief   |   April 01, 2005
Audiology in Brief
The ASHA Leader, April 2005, Vol. 10, 5. doi:10.1044/leader.NIB.10052005.5
The ASHA Leader, April 2005, Vol. 10, 5. doi:10.1044/leader.NIB.10052005.5
Audiologists Gain Ground at Wal-Mart
Wal-Mart has notified Blue Cross Blue Shield plans in four states-Alabama, Arkansas, California, and Illinois-that reimbursement claims submitted on behalf of their employees by independently practicing audiologists are not to be routinely denied. In addition, claims that were denied previously now will be reconsidered.
Last fall ASHA alerted Wal-Mart that reimbursement claims submitted by independently practicing audiologists were being denied, while the very same services provided and billed through a physician provider were reimbursed. These denials occurred despite the fact that, in both physician and audiology practices, it was the audiologist who performed and interpreted the diagnostic audiological testing, not the physician.
This physician-only requirement eliminated this important benefit for many Wal-Mart employees because of regions within every state served only by audiologists in independent practice. The physician-only requirement also significantly increased Wal-Mart’s cost to provide a diagnostic audiological benefit to its employees.
According to actuarial data prepared for ASHA by Milliman USA, the per-member-per month (PMPM) cost for audiological services is 10 cents PMPM when provided and billed by an audiologist. This figure increases to $1.75 PMPM when the same services are provided and billed by a physician.
For more information contact Maureen Thompson by e-mail at mthompson@asha.org or by phone at 800-498-2071, ext. 4431.
Audiology Direct Access Bills Need Co-Sponsors
ASHA and other audiology groups are seeking co-sponsors for H.R. 415 and S. 277, the “Hearing Health Accessibility Act of 2005,” as introduced by Rep. Jim Ryun (R-KS) and Sen. Tim Johnson (D-SD). This bipartisan legislation would allow Medicare beneficiaries the option of going directly to a qualified audiologist for hearing and balance diagnostic tests. Currently, Medicare beneficiaries with hearing loss or balance disorders are required to obtain a physician referral. This legislation would align Medicare with programs administered by the Office of Personnel Management (OPM) and the Department of Veterans Affairs (VA), which do not require a physician referral.
Visit ASHA’s Take Action site at http://takeaction.asha.org and send e-mail or letters to your members of Congress if they have not yet signed on in support of this legislation. If your legislators already are co-sponsors, you’ll get a default “thank you” letter to send. For more information, contact Reed Franklin by e-mail at rfranklin@asha.org or by phone at 800-498-2071, ext. 4473; or Linda S. Lucas by e-mail at llucas@asha.org or by phone at 800-498-2071, ext. 4427.
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FROM THIS ISSUE
April 2005
Volume 10, Issue 5