Don’t Forget Licensing & Credentialing!
You’ve just relocated to a new state or earned your Au.D. and can’t wait to join a hearing care team, but are you missing some important moves?
Achieving your dream of helping people live their best through better hearing requires professional licensing and credentialing before you can serve a single patient. Here’s how to kick your career into high gear.
Get Licensed
An audiologist cannot provide services to patients unless licensed in the state in which he or she intends to practice. Some states have two separate licenses — and possibly two separate licensure boards — for audiology and hearing-aid dispensing/hearing-aid services, so you’ll need to know:
- What licensure laws apply to you for all the services you provide
- The time frame in which you can start providing services to patients
It’s best to contact the licensure boards in your intended states as soon as possible, especially checking their websites for processes, requirements, and phone numbers or email addresses for questions and other follow-up.
Set Up an NPI
Every health care provider and health plan must have a unique identifier, per the Health Insurance Portability and Accountability Act, hence the online National Plan and Provider Enumeration System developed and administered by the Centers for Medicare and Medicaid Services (CMS). Through this system, you’ll acquire your own 10-digit National Provider Identifier (NPI) number, a prerequisite to credentialing and billing for your services.
Understand Credentialing
Credentialing, a process that facilitates recognition for reimbursement by contracted third-party payers, differs across Medicare, non-Medicare, and Medicaid insurance programs, so let’s break down the categories:
- Medicare — Whether you or the office manager at your practice makes it happen, it’s important that you’re enrolled as a provider promptly. You’ll need your NPI number, a copy of your terminal degree, and your license. If you’ll be part of a group, your practice manager can advise on the practice’s corporate structure, which may determine the enrollment approach. If you’re joining an independent audiology practice or an otolaryngology office, you will likely need to file the CMS form 855R to assign the benefits to the practice.
- Non-Medicare — Payers in non-Medicare programs will likely require enrollment in the Council for Affordable Quality Healthcare (CAQH) [LINK TO https://proview.caqh.org/PR/Registration], a repository where payers can confirm your credentials when processing your application to be a provider for their plans.
- Medicaid — Like licensing, Medicaid enrollment for audiologists is state-specific, with each jurisdiction having its own separate requirements for audiology and hearing-aid services. Consult the specific state’s website, and don’t hesitate to ask questions; the process can prove daunting even for more experienced providers!
Quick Tips
Early birds get the — well, you know the rest! Waiting till the last minute to apply for licensing only delays your eligible work date, putting your employment at risk, so don’t delay. Keep that and the following quick tips in mind to help start your new job on the right foot:
- Identify and abide by the rules and regulations promulgated by your audiology or hearing-aid-service licensure boards.
- Know the continuing-education requirements of your state. Failure to fulfill them could mean license suspension or a fine, so don’t hesitate to seek clarification from the applicable licensure board.
- Monitor CAQH every three months per the requirements. Otherwise, your application will lapse.
- Enroll in Part B Medicare, being sure to monitor the application for timely processing.
- Confirm through your practice administrator or office manager the insurance plans you’ll need to be credentialed with.
- Enjoy your profession and the fulfillment and satisfaction it will bring!
Did you know? Audigy offers credentialing and other crucial services for our members, making it easier to navigate third-party-payer networks and get the most out of contracts.
Not a member? Our experts are happy to answer your questions about licensure, credentialing, and Medicare enrollment. Don’t wait. Contact our knowledgeable team today!