Staying Ahead of Change - Preparing for the Potential Outcomes of Passage of the Big Beautiful Bill (HR1)

This is NOT a political post. This post is 100% a business operations and revenue cycle post. I want audiology practices to be prepared and ready for the potential changes ahead.

The passage of One Big Beautiful Bill Act (HR 1) on July 3, 2025 could mean that, over the coming months and next few years, there will be individuals who lose their health insurance, specifically those who obtained health care coverage through Medicaid expansion. As a result of these changes, I have the following recommendations for audiology practice owners and managers, irrespective of your Medicaid enrollment status (as more individuals will be uninsured and self-pay).

• Get copies of all applicable, valid insurance cards (front and back) prior to providing care.

• Verify insurance eligibility immediately prior (within the month of the date of service) to seeing patients, especially if providing  pediatric, vestibular, auditory prosthetic device, or hearing aid items and services that are being billed to a health plan. This can be accomplished through online portals.

• Provide a written good faith estimate 1) if seeing a patient more than 72 hours from the time and date of scheduling and 2) if any items or service will be self-pay. This is a state and federal requirement that applies to both in and out of network providers.

• Collect all patient responsibility (all usual and customary charges from those without insurance and unmet deductibles, applicable co-payments and co-insurance, and charges for priorly notified non-covered services for those with insurance) on the date of service.  It is important that you have patient-facing (websites, forms) financial policies that address this requirement.

• Do not self-finance (there are state and federal finance laws the govern this).  Have a financing option available and accept multiple forms of payment.

• Become familiar with the medical coverage and payment policies of every health plan your practice participates with or sees patients from (as some coverage policies apply, whether in or out of network).

• Do not attempt to get retroactive orders, referrals, or prior authorizations.  It is important in these situations to wait until you have all required orders (Traditional Medicare), referrals (HMOs) and prior authorizations (Medicaid and Medicaid MCOs, worker’s compensation, vocational rehabilitation, schools, employers) before providing care, especially for hearing aids. You run the risk, in these situations, of non-payment (which would be legitimate) and, in many cases, you cannot assign responsibility to the patient if you are a participating provider.

• Re-evaluate your participation status with each, individual health plan, including Medicaid and Medicaid Managed Care Organizations (MCO). This can be accomplished with a cost versus benefit analysis for each plan. Medicaid and Medicaid MCOs can be slow payers (more than 90 days), which can become problematic if your clinic purchases the hearing aids, yourselves, directly from the manufacturer.

• Consider a separate fee schedule. Medicare, Medicaid and commercial health plans contractually allow for you to have a different usual and customary rate for indigent patients. They just require that you establish a specific, documented policy for determining who meets your indigency criteria and that this policy is consistently applied.

It is valuable, in any business, to hope for the best, yet prepare for the worst.  This is the sole intent of this piece. The goal is always to be one step ahead of change and be prepared for what COULD occur in some states and regions.