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Do you think that telehealth SLP services will be reimbursed by insurance companies beyond this time of covid?
Rinki Varindani Desai
Hi Dorothy. That is the hope and what we all are advocating towards at the local, state and national levels. It will be important to collect data to demonstrate the need and benefit of telehealth during this period - to help support our case. Other speakers might have additional thoughts. Thanks for your question.
I think it is up to us. If we do not abuse the system we will have a good chance of continuing. Regulations are typically developed in response to how the industry operates.
I’ve been a FT home health SLP for the past 6 years. As you know, PDGM went in to effect last January and on top of effects from the pandemic, HH branch directors (RNs) dictate to me that I can have 4 visits total (eval included in that count). They’ve even specified which weeks I have to “miss” or when I can start my treatment (in the last 30 days of the 60 day episode). I will say it is disheartening to tell patients and their families how many subsequent visits we get, and even further so to make really minimal to no progress when “given” 1 visit a week for 4 weeks. I understand balancing functional outcomes with minimal necessary visits (to keep efficient with costs), but this drastic of a limit on visits seems that PDGM and for-profit home healths are being set up to fail…..
the ripple effect of this is low caseload. I’m now working 6 PRN jobs to try and piece together a FT schedule.
Susan L Browning
Coding is always complex--the medical dx can certainly play a role, especially as it relates to cognitive-communication
Interesting about the cognitive codes.... we don't routinely bill those timed codes 97129 or 97130 in Senior Living as they have been denied. If they did not have a recent medical diagnosis that impacts cognition such as a TBI it has been denied in the Midwest. We have routinely billed 92507 instead
Same in Hawaii- Michele
I work in peds, we are discouraged from using F-codes when working with families with private insurance because they are typically denied. Can you please shed some light on why this may be the case?
Susan L Browning
Documentation is everything with medical necessity, beyond just the medical dx itself. My experience is that all payers need it spelled out in extensive detail.
ASHA resource: https://www.asha.org/practice/reimbursement/medical-necessity-for-audiology-and-slp-services/
PREACH RINKI (diets)
@Dorothy Freas, I have the same experience.
ASHA resource: https://www.asha.org/practice/reimbursement/medicare/documentation-of-skilled-versus-unskilled-care-for-medicare-beneficiaries/
exactly. we have to document our outcomes and collect data!
Dorothy F codes are often considered by Payers to be in the realm of mental health and they have separate coverage policies and limitations for provider recognition in that area. That is not absolute and conditions like autism can be referenced in that section but the over-arching problem you referenced is that mental health perception.
ASHA resource: https://www.asha.org/practice/reimbursement/medicare/slp_coding_rules/#:~:text=Speech%20language%20pathologists%20may%20perform,by%20physical%20or%20occupational%20therapists.
is using ASHA NOMS for this effective to show progress and severity of the impairment?
The It seems absurd that we, as non-physicians are required to determine medically necessity for coverage. I believe only a physician should be responsible for using the words medical necessity.We can easily determine clinical intervention necessity.
Yasmin - are NOMS validated measures? i’m not super familiar with how they’re used.
Hi Jessica- here is some info on NOMS: https://www.asha.org/noms/
NOMS can be helpful at demonstrating you ability to deliver results. The NOMS measures show progress over a course of therapy and are benchmarked against other SLPs across the nation. . The NOMS measures are validated but somewhat subjective too. The attainment of goals is within parameters and ordinal but not necessary ratio based, speaking from a statistical perspective.
Yes. first establish parameters and expectations, then revise if needed.
Susan L Browning
I would love to hear any info on updates regarding a possible group dysphagia code.
what was the title of rinks article?
Build a Case For Instrumental Swallowing Assessments in Long-Term Care
When looking at productivity discussions with new employees, I like to highlight when we are efficient and attain "x" outcomes in visits that are "x" number of minutes / units. That is followed by when we demonstrate value we gain additional referrals and that keeps us all employed.
Also we had an opportunity to look at barriers to productivity as we just switched EMR's. We switched to point of service (or documenting immediately after the session) and with the purchase of iPads to do this documentation our productivity soared.
ASHA resource: https://www.asha.org/practice/reimbursement/medicare/medicare-patient-driven-payment-model/
ASHA resource: https://www.asha.org/practice/reimbursement/medicare/medicare-home-health-prospective-payment-system/
Michele- Great point about using innovation and technology to break down barriers o productivity and efficiency in general. Having those tools are critical.
We are looking to figure out how to get payors to reimburse more of what we are worth- then productivity wouldn't be as strict, and we could pay better rates...productivity is just a labor measurement so we can bring in enough to pay them...
I see a lot of PTs & OTs (I'm usually the only SLP) doing paperwork off the clock. My DOR comes and complains that "everyone else meets productivity". I've tried the minute-by-minute documenting and been told it doesn't matter. The DORs I've worked for in SNFs just don't want to even look at it! They just keep repeating that everyone else can do it.
Kristina, there is terrible downward pressure on health care reimbursement based on the for profit industry taking funds out of the system. Our evaluations are very highly paid by Medicare $235 for 92523 yet our evals are discounted in a SNF setting and sometimes completely excluded from the productivity standards. We are always trying to increase the value of our codes relative to other services and other providers. That process falls to surveys that we send to ASHA members whenever the codes are re-valued where respondents can help us accurate determine the correct "relative value" of our codes compared to the rest.
sandra - what if they asked the PTs and OTs to do minute by minute documentation too? what it sounds like they’re saying is “they are ok with this plan, so you should be too"
thanks, Tim. I always participate in the surveys!! Do you guys get a good response rate?
Jessica - the other issue with PT & OT is that often the patient is doing something like using the hand bike or other fairly independent equipment that allows the PT/OT to document while the patient does the exercise. I can't talk to a patient and write notes at the same time.
Very good response rate compared to other professional societies. We usually have many multiples over the number required for validity by the AMA process.
I encounter the same issue in outpatient, Sandra Nelle
Sandra - one might say, that our minutes billed are more valuable to the patient in that context, as they cannot do it without our constant support. Not to dog on PT/OT obviously, just a comment.
Sandra, we do try to make that cae to the industry as well. Point of Service is good but it can't take away from actual patient care...
In SNF/HH/LTAC I try to use the last 5-10 min as a recap (by the patient) of all we completed that session so that we are interacting but I have a few moments to document.
Rinki Varindani Desai
Encourage everyone to read about value-based healthcare and payor - provider collaborations to improve patient outcomes. Lots that can be applied from other professions to our practices.
Agree Cassie - that is what we do, works well!
Cassie, sounds like a good compromise approach.
Sandra, I'm huge on educating my staff to review the documentation with the client as they do it- I think it also helps them to understand what we are really working on and hearing their progress- "last week you were doing xyz, this week we did better by doing abc, what do you think we can get next week..." get them involved to help motivate and gives them the review they need so they wont say "we did nothing in ST today" lol
Susan L Browning
I love to let SLPs know that ASHA can do more for them than anyone ever realizes!
(then after talking- I say "great, let me write that down"...then I document)
thanks this was helpful
Thank you - love this format!
Thank you for this session! Love the advocacy for this setting
Thank you for this presentation! As a graduate student this is very eye opening!
thank you all for your contributions
Thank you so much!