Volume #35 - December 2021


Audiology Resources

Monthly News & Updates


Wow, has 2021 another wild ride, both on the personal and professional front! I am anxiously awaiting the return of my only child from her freshman year of college abroad. I need a big mom hug! I am looking forward to some much needed family time (aka time away from audiology). I hope the stars align and this is possible. Like many of you, I need a recharge to take on the new year and all it holds.

2022 looks like it is also going to be another crazy ride! OTC Final Regulations, Build Back Better hearing aid provisions, COVID...the list goes on and on!

In 2022, I will be offering some very different training opportunities based upon feedback from my course attendees and survey respondents. While I still strongly recommend and offer my Foundational Boot Camp, I have developed three, new courses based upon feedback. These include a small group, eight-week, Audiology Front Office and Billing Staff Basic Training on Coding and Reimbursement (only a few spots remain), four, small group, time zone sensitive Advanced Boot Camps (for recent foundational boot camp attendees; only a few spots remain in the EST course) and a Hearing Aid Revenue Cycle event, which solely focuses on effectively billing hearing aids to insurance. I am so excited to help practices increase revenues and efficiencies!

Thank you to all of you who responded to my survey! Please watch your mailboxes for those who have won the free boot camp registrations for being so generous of their time through participation!

I wish you and your families and staffs a safe, happy, Holiday Season!



2022 Boot Camp and Training Event Schedule Now Available. Click on this link to learn more or register!

Monthly Coding and Reimbursement Tips

NU Modifier

Use of the NU modifier (on a claim) can be required in managed care situations where the payer considers hearing aids to be durable medical equipment (DME). The NU modifier is a DME modifier. It indicates that the beneficiary is receiving a new item and NOT a replacement or rental item..

There are other valuable modifiers in this category:

  • RA: Replacement of a DME, orthotic or prosthetic item.
  • RB: Replacement of a part of DME, orthotic or prosthetic item furnished as part of a repair.

The requirement for use of these modifiers can vary payer to payer. Please consult payer medical policies and billing guidance.

New Front Office Basic Training Now Available  

Research Spotlight on Cognitive Screening

Audiologists reach out to me all of the time asking my thoughts on Cognitive Screening. I always try to defer to the evidence that is available.

The Shen et. al piece on cognitive screening tests in Audiology is ALWAYS a must read. The same goes for the Humes piece on associations between measures of auditory function and cognitive screening.

There are many alternatives for screening for cognition. One that is mentioned in both pieces is the MoCA. Audiologists can be certified in the administration of the MoCA for $150 at https://www.mocatest.org.

What Are Audiologist's Unique Offerings


I have been exploring different pathways to learn more about business and consumer perceptions. I have been following consumer comments in a hearing loss/hearing aid Facebook group. I find the comments equal parts sad, intriguing and fascinating. I am also in the midst of becoming a Pumpkin Plan Strategist. In this process, I have learned a great deal about business, how to flush out what our patient’s wishes are or might be for an audiology practice and what unique offerings still exist in the space as it pertains to quality, price or convenience.  

I have been melding this information together and have come up with several thoughts and ideas on how audiologists can grow their practices and increase profitability. Let’s break down how we can better meet the needs of today’s hard of hearing and balance and communicatively impaired consumers:

1.    Skills, education and a comprehensive scope of practice

Despite allowing the continued use of the term “hearing care professional”, AUDIOLOGISTS are uniquely educated and licensed to provide comprehensive, hearing and balance services. We are the “gold standard” and experts in hearing and auditory communication IF we consistently practice to the research evidence. This means consistently providing evaluation, management and treatment beyond the rudimentary audiogram and “first fit” hearing aid fitting (because, if this was all you planned to do, I have no idea why the patient could not do this themselves). This includes, but is not limited to, the use of standardized questionnaires and inventories, cognitive and APD screening, CEDRA, speech in noise testing, electroacoustic analysis, real-ear measurement, integration of assistive technologies and accessories, cerumen management and auditory rehabilitation. Many of these services are NOT offered by or available through Big Box or online retailers.

Your degree, title and license ALONE are not enough!

“Quality” is a title earned and assigned by the patient, not you. You have to behave like a doctoral professional if you want to be respected like a doctoral professional. We have to be better than the competition if we expect consumers to pay more for our care delivery. No one can compete with Costco or over the counter (OTC)/direct to consumer (DTC) retailers without offering a different experience or standard of care. Period. It all begins and ends with the consumer journey.

2.    Insurance coverage

Insurance is my gig. I know a great deal about it in our space. I can tell you that most audiologists can be successful in the managed care arena if they educate themselves and their staffs on the revenue cycle process, apply their knowledge consistently, and rethink their care delivery and pricing models. I see it EVERYDAY! I can teach those who are willing and want to learn and apply that knowledge to their clinics.

The trend though in audiology is to be out of network. Folks expect full usual and customary cash on the barrelhead. This decision is made for a plethora of reasons, some of them viable, many of them not.

You see, one thing we have over most of the competition is the ability to access a consumer’s health insurance, VA and worker’s compensation benefits. This means insurance coverage administered by third-party administrators as well. Costco does not take insurance. Neither do most OTC/DTC retailers. Dispensers cannot generally bill for covered evaluation or rehabilitation services.

This can be something that sets us apart. Makes us attractive despite our higher costs. So, please understand, that the more we reject insurance, the more we push consumers to lower cost, value based care channels. Think about it AS A CONSUMER YOURSELF! What would you do?

3.    Independence

Consumers like small, local, independent businesses, especially when they believe the audiology providers to be unbiased, trustworthy, transparent and honest. Many are willing to pay more to support a business that is truly looking out for their best interests and entrenched in the community.

Many consumers are turned off by Big Box, online, franchise and manufacturer owned retailers (when they are aware of manufacturer ownership, but that conversation requires another blog). They WANT to BUY LOCAL and want a RELATIONSHIP with a local audiologist. Many want and need a navigator for their hearing loss journey.

We though have to BE LOCAL. We have to engage in our communities. Become part of the fabric. Get out there. Be seen and heard. Engage. Join. Be the EXPERTS everyone turns to and hankers to see by LISTENING to the consumer, meeting THEIR needs, and providing comprehensive, evidence based care.

4.    Accessibility/convenience

The world of healthcare and retail sales have been rapidly evolving over the past decade. With the advent of urgent care, we no longer function, as healthcare consumers, in a Monday through Friday, 9 to 5 world. The ease of Amazon has made it even worse in retail channels. Consumers want care that is more accessible and more convenient. They expect it because they experience it in everyday life with other entities.

Consumers WANT telehealth and remote adjustment. This care delivery is becoming commonplace with DTC hearing aids, such as Lively and Eargo and will only grow with more OTC offerings. If we build it, folks will come.

Audiology clinics, especially private practices, have a huge opportunity to be a leader in telehealth and accessibility. You, the practice owner or manager, control provider availability (schedule), telehealth access, e-commerce offerings, and convenience (walk-in hours, location, parking, timely text and email communication, etc.). 

NOW is the time to be a leader in a new access model. This can differentiate you from Big Box and institutional providers.

5.    Pricing

Most of us cannot compete with Costco on price. Heck, most of us pay more for the product than the price Costco sells it to consumers. We can though make our prices 1) more transparent (so consumers know what they are paying for), 2) more flexible (pre-paying, upfront, for long-term care becomes optional) and 3) more comprehensive (with OTC and value based solutions available). Consumers have been patiently waiting for us to evolve our pricing models for a decade. They turned to alternatives when we refused to listen to them and their needs. When we REFUSED to budge!

You CAN compete with many of your competitors on price. You just have to create a pricing model that differs from your competition. It’s time to stop doing what everybody else has done for 50 years. It is time to offer more transparent, patient centered pricing.

6.    Capacity to provide evaluation, treatment and rehabilitative services in one location and in one visit.

Most of our competition cannot meet all of the consumer’s needs under one roof. Costco and most manufacturer or hearing aid dispenser owned or operated practices cannot or do not provide cerumen removal, CROS/BICROS, tinnitus evaluation and management or implantable devices. They also do not evaluate the consumer beyond the product. These providers have to refer all of these services out.

Audiologists have a unique opportunity to offer comprehensive, whole patient care within their practice. You can become a one stop shop for your patients, which increases convenience and practice satisfaction.

It is time that we ALL become more than educated hearing aid dealers and practice at a doctoral level. Become EVERYTHING ears, hearing and communication! Have an e-commerce store where you curate everything a consumer would ever need to manage their hearing loss, communication issues, or, even, ear wax (and create passive income in the process)! Reduce their need to “shop” or be seen elsewhere!

Again, as I keep repeating over and over and over again, month after month and year after year, OPPORTUNITIES exist. Stop listening to manufacturers and buying groups who need you to maintain YOUR status quo to maintain THEIR status quo. Let 2022 be the year to chart YOUR course, not theirs.

Are YOU FINALLY ready and willing to do the things that differentiate audiology and audiologists from other competitors?

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