Reimbursement, Practice Management Issues, and Ethics

ABSTRACT

In the day-to-day life of an audiologist, he or she may not always consciously consider the laws that must be abided to function in a productive and ethical manner. The Medicare/ Medicaid Anti-Kickback Statute, Stark Laws, and Health Information Portability and Accountability Act are discussed in this article as well as suggestions for optimizing chart documentation, strategies for legally dismissing a patient, protocols for referring to another audiologist, and recommendations for coding appropriately.

KEYWORDS

Stark laws - Medicare/Medicaid anti-kickback statutes - Health Information Portability and Accountability Act

REFERENCES

• 1 American Academy of Audiology Ethical Practice Guidelines on Financial Incentives from Hearing Instrument Manufacturers .http://www.audiology.org/professional/positions/ethics.pdf Accessed May 28 2006
• 2 Medicare/Medicaid AKS. 1998. http://Available at: www.bricker.com/legalservices/practice/hcarelawusc/320a.asp Accessed June 5, 2007
• 3 Abel D, Hahn R. Ethics in Audiology: Guidelines for Ethical Conduct in Clinical, Educational, and Research Settings. Reston, VA; American Academy of Audiology 2006
• 4 The Public Health and Welfare . Chapter 7: Social Security subchapter XI-general provisions, peer review, and administrative simplification. Part A-General provisions.  http://Available at: www.complianceland.com/akstext/42usc1320a7b.html Accessed June 5, 2007; 
• 5 Abel D, Hamill T. Don't “fall” into hazardous practice.  Audiol Today. 2004;  16(4) 30
• 6 Kinkade W. Anti-Kickback Act Safe Harbor Provisions Finalized. Findlaw for Corporate Counsel. Available at: http://articles.corporate.findlaw.com/articles/file/00130/001046/title/Subject/topic/Health%20 Accessed July 10, 2001
• 7 Office of the Inspector General .Special Fraud Alert: Rental of Space in Physician Offices by Persons or Entities to Which Physicians Refer 2000 http://Available at: www.oig.hhs.gov/fraud/docs/alertsandbulletins/office%20space.htm Accessed May 28, 2006
• 8 The Public Health and Welfare .Chapter 7: Social Security subchapter XVIII-Health Insurance for Aged and Disabled http://Available at: www.bricker.com/legalservices/practice/hcare/lawsusc1395nn.asp
• 9 American College of Obstetrics of Obstetricians and Gynecologists .Stark II. Phase 1: The Self Referral Law 2004 Available at: http://www.acog.org/from_home/departments/category.cfm?recno=19&bulletin=1788 Accessed June 5, 2006
• 10 Center for Medicare and Medicaid Service .2009 Medicare program, competitive acquisition for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and other issues. http://Available at: www.cms.hhs.glv/competitveacqfor dmepos/downloads/cms-1270-f.pdf Accessed June 10, 2007
• 11 Chappell J. Health Care Policy Director, American Academy of Audiology. HIPAA: Are you Compliant? Presented at: the Ohio Audiology Conference February 22, 2003 Columbus, OH;
• 12 AMA .Current Procedural Terminology (CPT). Standard edition, 2007. Chicago, IL; American Medical Association 2006
• 13 International Classification of Diseases. 9th revision. Seattle, WA; Ingenix 2006
• 14 Healthcare Common Procedure Coding System. Medicare's national level II codes. HCPCS 2007. Chicago, IL; American Medical Association 2007
• 15 American Academy of Audiology .Code of Ethics and Procedures, Rules & Penalties. http://Available at: www.audiology.org Accessed June 30, 2004

Appendix A Additional Reading Material

• 0 Garstecki D C. Morals, ethics, laws, and clinical audiologists.  Semin Hear. 2000;  21(1) 21-32
• 00 Jonsen A, Siegler M, Winslade W. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 4th ed. New York; McGraw-Hill 1998
• 000 Liang B A. Fraud and abuse in audiology: the law of conflict of interest.  Semin Hear. 2000;  21(1) 41-62
• 0000 Panneback M, Middleton G F, Vekovius G T. Ethical Practices in Speech-Language Pathology: Case Studies. San Diego, CA; Singular 1996