Today ADA sent out an alert by Kim Cavitt that is well worth actually reading; one of those things that makes your ADA dues worthwhile. Perhaps even worth printing off and keeping in your files for quick refresher guidance later.
Some managed care programs are requesting Audiologists provide "free" services to become a participating provider. This puts them in apparent direct conflict with any office that is a Medicaid or Medicare provider. ADA is warning Audiologists that take Medicare to avoid any of these arrangements.
Your ability to follow Medicare rules, or your professional ethics, isn't the managed care provider's problem. It is your problem. They will happily allow, or even encourage, you to violate the "other guy's" rules.
This is one of those times when it is good to be working in an Audiologist Owned and Managed practice. You can decide as an Audiologist if you need to participate in one or another, or opt out of one or another. If you work in a non-Audiologist owned location you may easily find yourself caught in a trap where you will be in violation because someone else made the decisions.
You might even find yourself in a situation where the people who are supposed to be on your team will be encouraging you to do what is not appropriate. In these situations the Audiologist, you, is the one who will get in trouble. Not the person or persons encouraging you to act a certain way for their profit.
I expect for some of you this will be the last straw for you and you may find it time to exit the Medicare program as the risk / reward structure may have shifted excessively.
Perhaps if ADA, AAA, and ASHA could get every audiologist to opt out it would have an impact on the decision makers, whoever they actually are, but that isn't going to happen.
Kim includes a nicely prepared listing of some of the applicable statutes for your review.
Something that I found very interesting in what she included is that apparently inexpensive, non-cash, gifts are actually specifically permitted. Less than $10 appears to be the value limit. OK, that isn't much, but it does appear to mean a few batteries, a container with your name on it to keep their hearing aid in, some business cards, or couple of pens with your name on them would not be a problem. Or you might send them newsletters or cards and not be in violation. This I would think would be useful to you in serving the hearing impaired.
If you missed the e-mail I expect it is available to ADA members on the membership only section of their site www.audiologist.org. I didn't have my ADA userid or password handy and there doesn't appear to be a directly accessible link I can post here, sorry.
One of the problems with these government programs is that enforcement is impossible to predict; a little like speeding on the freeway. Everyone else may be driving faster than the posted limit, and you have never driven over the speed limit in your life, yet if you happen to drive past a police officer who has time you may find yourself the only one in trouble. Except in this case with government medical reimbursement there is no actual posted speed limit. They just tell you at some speed bad things might happen to you.
Now you must figure out how to proceed.
I hope this helps you,
Rick
