Praxis 5343: Professional Issues & Ethics

Stark Law

Physician referrals. If a physician or family member has financial relationship with an entity that provides designated health services that the dr. may not make a referral for any health services that is reimbursable by Medicare, and the entity may not bill for the services as a result of the referral

Anti-Kickback Law

Prohibits the solicitation, receiving, offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange.

2. What features of research support generalizability of findings?

'High external validity' 1. Large sample size & ramdom sampling: test group is relatively large and randomly chosen (not over 10,000) 2. Replication - Specific tests in the original environment gives the same results in different circumstances. - Focus on measurements, than treatments. It must produce the same results with different forms of measurement.

NPI

(National Provider Identifier) = required by all providers to bill National Plan and Provider Enumeration System (NPPES). Audiologists, hearing aid dispensers and audiology assistants can obtain an NPI. However, being eligible to obtain an NPI does not mean you can bill for items or services. You can apply for an

Modification code for extended procedure

-22

Modification code for incomplete procedure

-52

Before administering a test, what must you do? How can you be sure it is an appropriate measure for the intended client?

..

In what situations would it be necessary to obtain permission from an audiology patient or parent of a patient?

...

For those residents who are already using amplification when they enter a facility, the audiological assessment should, at a minimum....

1 include a visual inspection of the hearing aid(s), earmold(s), and tubing, 2. an electroacoustic evaluation of the hearing aid(s) with real ear measurements and/or self-report data.

An audiology aide means a person who:

1. Assists or facilitates while an audiologist is evaluating the hearing of individuals and/or is treating individuals with hearing disorders, and Is registered by the supervisor with the Board and the registration is approved by the Board. 2. An audiology aide must complete a training program established by the supervisor. 3. The number of audiology aides supervised shall not exceed three. However, the Board may authorize more than 3 supervisees if, in its discretion, the supervisor demonstrates that the public health and safety would not be jeopardized and that he or she can adequately supervise more than three aides.

Roles of AuD in nursing homes and assisted living care?

1. Audiologic Screening: to identify those in need of audiological or medical services necessary to ensure their health, safety, and maximal functioning & should occur within the first 2 weeks of entry into the long-term care system 2. Audiologic assessment: (a) determine the need for medical and/or rehabilitative intervention; (b) identify residents with hearing loss who have been misdiagnosed as "senile" or "depressed"; and (c) assess the rehabilitation potential of residents 3. Referral and Intervention Options 4. Hearing Aid Assessment and Fitting 5. Assistive Listening System/Device Selection and Considerations 6. Orientation-Maintenance Program 7. Caregiver Education: The audiologist should provide regular and periodic in-service training for nursing home staff to support the rehabilitation program designed for the resident and to provide carryover of therapeutic aspects into their daily lives The in-service program should include: -cause and functional effects of presbycusis; -psychosocial effects of hearing loss; -realistic expectations about hearing aids; -hearing aid troubleshooting procedures; -methods to facilitate communication; and procedures to report lost aids. 8. Documentation 9. Discharge Planning

How does coding for diagnosis and billing work in audiology?

1. CPT codes: procedural code - Current Procedural Terminology (CPT®) codes (developed and maintained by the American Medical Association) are five-digit codes that designate a distinct test or therapeutic procedure 2. ICD-10 codes: diagnosis - The International Classification of Diseases (ICD) codes are numeric or alpha-numeric codes that are used to classify a diagnosis 3. HCPCS: equipment/device

Risk Assessment Procedures

1. Evaluate the likelihood and impact of potential risks to e-PHI. 2. Implement appropriate security measures to address the risks identified in the risk analysis. 3. Document the chosen security measures and, where required, the rationale for adopting those measures. 4. Maintain continuous, reasonable, and appropriate security protections

Describe the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

1. HIPAA Privacy Rule protects the privacy of individually identifiable health information 2. HIPAA Security Rule sets national standards for the security of electronically protected health information 3. Patient Safety Rule protects identifiable information being used to analyze patient safety events and improve patient safety. 4. HIPAA Breach Notification Rule requires HIPAA covered entities and their business associates to provide notification following a breach of unsecured protected health information

What is the role of an audiologist on an Individualized Education Program (IEP) team?

1. Initial Screening and Assessment: medical referral (e.g., possible otitis media) or child study or response-to-intervention (RTI) team to address potential interim learning issues. 2. Interdisciplinary Team Meeting: done before referral to Special Ed. a. AuD must Provide team members with written information on instructional access (e.g., specific classroom accommodations). b. If accommodations such as captioning or classroom audio distribution systems are recommended, a 504 Plan should be implemented, and the educational audiologist should attend in person or participate virtually (e.g., conference call, Skype) when this plan is written. 3. Referral for Special Education - when strategy Under RIT didnt work. a. When a community audiologist is involved with the student, close collaboration with school- based professionals during the assessment process is strongly recommended. b. Educational audiologists can expand a traditional audiologic battery to include classroom observations and functional listening evaluations 4. IEP meeting = required by IDEA

In what circumstances is advocacy for a patient by an audiologist required and appropriate?

1. Patient's needs and safety. 2. Employee needs and safety. 3. Responsible use of resources. 4. Financial health of organization.

What is a standard procedure to ensure that all members of the office staff are conforming to HIPAA?

1. Policies and procedures in writing. 2. Annual training for staff. 3. Training for new hires. 4. Have staff sign HIPAA form.

Guidelines for Audiology Aides role

1. The roles and tasks of audiology assistants are assigned only by supervising audiologists. 2. Supervising audiologists provide appropriate training that is competency based and specific to job performance. (The supervising audiologist is responsible for maintaining written documentation of completed training activity.) 3. Supervision is comprehensive, periodic, and documented. The supervising audiologist maintains the legal and ethical responsibilities for all assigned audiology activities provided by support personnel. 4. Services delegated to the audiology assistant are those that are permitted by state law, and the audiology assistant is appropriately registered/licensed if the state so requires. 5. The audiology assistant meets minimum qualifications for audiology assistants per ASHA guidelines. 6. The needs of the consumer of audiology services and protection of the consumer are always paramount.

Support personnel may assist audiologists in the delivery of services, where appropriate, provided these guidelines are followed.

1. The roles and tasks of audiology assistants are assigned only by supervising audiologists. 2. Supervising audiologists provide appropriate training that is competency-based and specific to job performance. 3. Supervision is comprehensive, periodic, and documented. 4. The supervising audiologist maintains the legal and ethical responsibilities for all assigned audiology activities provided by support personnel. 5. Services delegated to the assistant are those that are permitted by state law, and the assistant is appropriately registered/licensed if the state so requires. 6. The needs of the consumer of audiology services and protection of that consumer are always paramount.

Audiology assistants improve access to patient care by

1. by increasing the availability of audiology services, 2. increase productivity by reducing wait times and enhancing patient satisfaction 3. reduce costs by performing tasks that do not require the professional skills of a certified and/or licensed audiologist

What provisions of educational legislation (e.g., the Individuals with Disabilities Education Act [IDEA]) have an impact on audiologic practice?

1. https://www.asha.org/policy/gl2002-00005/

Appropriate Roles of audiology tech/aide

1. performs delegated tasks that are prescribed, directed, and supervised by a certified and/or licensed audiologist 2. When hearing aid dealers are serving in the role of assistant, their duties will always be clarified by the supervising audiologist 3. Audiology assistants may or may not be regulated by state laws and regulations, and the supervising audiologist is responsible for determining the applicable requirements in his or her state and work setting

If the hearing loss does not affect educational performance, the student typically will not be eligible for special education, consider

1. provision of supports and services under a 504 Plan 2. RTI should be considered.

Two (2) Roles of AuD in nursing homes

1. to gain an understanding of the patient's function and the patient's perceived needs, abilities, and limitations. 2. apply standard procedures in nonstandard settings to attain a complete picture of the resident's current hearing status and audiological rehabilitation needs.

Suprathreshold word recognition testing goals in nursing homes?

1. to identify persons who need assistive technology, which would promote communication among residents, residents and caregivers, and residents and family members. 2. The secondary goal is uncovering peripheral or central auditory processing difficulties.

Three (3) Goals of Nursing homes

1. to restore and maintain the highest possible level of functional independence; 2. to preserve individual autonomy; 3. to maximize quality of life, perceived well-being, and life satisfaction; and 4. to stabilize chronic medical conditions.

Cpt code for tymps + reflexes

92550

CPT CODE FOR COMPREHENSIVE AUDIO EVAL

92557

Cpt code for tympanometry

92567

Cpt code for tymps+reflexes+decay

92570

Law vs. Ethics

A law refers to the systematic body of rules that governs a whole society and the actions of its individual members. Ethics is a branch of moral philosophy that guides people about their basic human contact and human conduct. Laws are a set of rules and regulations and ethics is a set of guidelines. Laws are governed by governments and ethics are often governed by an individual's legal and professional norms. Laws are typically in writing and ethics can be abstract. Legal violations may not be permissible and can result in punishment, whereas ethical violations that aren't illegal often times don't have punishment. Laws are created with the intent to maintain societal order and peace in society, whereas ethics are about right and wrong and how people treat each other and how they want to be treated.

Discuss the confidentiality of patient records as prescribed by the American speech language hearing Association code of ethics

Access to these records shall be allowed only when doing so is necessary to protect the welfare of the person or of the community, is legally authorized, or is otherwise required by law.

What does 92557 include?

Air, bone, srt, wrs

3. What is a human subjects board?

Also institutional Review Board (IRB). Under FDA regulations, an IRB is an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects.

How and when do you do biologic calibration of hearing instruments (audiometer, tympanometer, OAEs)?

Biologic calibration done on a daily basis and electroacoustically on an annual basis.

False Claims Act

Do not submit fraudulent claims to any entity. 1. Billing of hearing aids that you did not fit 2. Billing under someone else's provider number 3. Upcoding 4. Billing for services known not to be covered and not adding the appropriate modifier 5. Submitting claims for services which were not medically necessary and not adding the appropriate modifier:

IDEA Eligibility (school aged) Part B?

IDEA requires that the hearing loss must adversely affect educational performance across 1. functional, developmental, and 2. academic areas (34 CFR §300.8[b][3][5]). Areas to consider include 1. communication difficulties, 2. language and literacy problems, 3. math deficits, 4. social/behavioral issues, and 5. challenges with self-advocacy and independence.

4. Who determines whether a task required by a subject in an experiment may be invasive?

IRB?

2.1 Differentiate good and poor generalizability

If the results of a study are broadly applicable to many different types of people or situations, the study is said to have good generalizability. If the results can only be applied to a very narrow population or in a very specific situation, the results have poor generalizability.

5. "dependent variable" and "independent variable" as they relate to experimental design.

Independent variable (IV) - What the experimenter controls. It is the cause. Its value is independent of other variables in your study. Dependent variable (DV) - The behavior that is measured by the experimenter to see if the IV affects it. E.g. you are studying the effects of alcohol (IV) on memory (DP).

When should unethical (or suspected unethical) conduct be reported to appropriate licensing or regulatory boards?

Individuals shall report members of other professions who they know have violated standards of care to the appropriate professional licensing authority or board, other professional regulatory body, or professional association when such violation compromises the welfare of persons served and/or research participants.

6. What is informed consent?

Informed consent requires that patients in clinical settings and participants in research voluntarily agree to a proposed plan based on their understanding of a clear and thorough explanation of purpose, risks, benefits, and alternatives. - It consists of providing adequate information to the subject about the study, giving the subject the opportunity to consider options, responding to questions the subject may have and ensuring that the subject or the legal representative (parent or guardian) understands the information

Interpreter vs Transliterator vs Translator

Interpreter—a person trained to convey spoken or signed communications from one language to another. Interpretation services may be provided Transliterator—a person trained to facilitate communication for individuals from one form to another form of the same language. Translator—a person trained to translate written text from one language to another.

EIN

National Employer Identification HIPAA requires that each individual practice or facility utilize their own distinct and unique practice or facility identification number. This is required for every practice and facility except for a sole proprietor. issued by the Internal Revenue Service. Each practice also needs a facility NPI

How long is it necessary to keep patient records?

The Health Insurance Portability and Accountability Act (HIPAA) requires to maintain required documentation for a minimum of six (6) years from the date of its creation, or the date when it last was in effect, whichever is later. CA: 7 years

ICD codes

The International Classification of Diseases (ICD) codes are numeric or alpha-numeric codes that are used to classify a diagnosis.

1.2 What is Type II error in a statistical research?

The probability of incorrectly rejecting a false null.

1.1 What is Type I error in a statistical research?

The probability of incorrectly rejecting a true null.

HIPAA 5010

This update allows for the transition of the seven characters of ICD510, vs only 5

When do we use an interpreter?

for individuals who use a language other than spoken English must be delivered in the language most appropriate to that student, client, patient, or family.

1. What is the meaning of statistical significance?

the probability of rejecting the null hypothesis ( the lower, the more significant) The likelihood that the results are not random or based on chance. -The claim that a result from data generated by testing/experimentation is not likely to occur randomly or by chance, but is instead likely to be attributable to a specific cause. -It is usually determined if the p-value is less than the cut-off, which is usually 0.05 or 0.01.

CPT Codes

Current Procedural Terminology (CPT®) codes (developed and maintained by the American Medical Association) are five-digit codes that designate a distinct test or therapeutic procedure. Each code has a description of the procedure or group of procedures that are included with the code.