There are examples of this and I want to give you a current example because of the public health emergency that we are in right now. So if it's a covered benefit, then there's no reason for the beneficiary to be paying you out of pocket. The reason for that is that speech-language pathology services are a covered benefit in Medicare and Medicaid. You are also required to have a claim form and I have provided an example of an ASHA model below ( Click here for larger version of Figure 1).Īlso, self-pay is usually not an option for Medicare or Medicaid beneficiaries. In other words, you need to have written policies and procedures, so that all of your clients are treated consistently. The rates are the same regardless of the payer and any discounts need to be standardized and uniformly applied. Your charges must be usual and customary. When you are in private pay, your rate setting guidance remains the same. This is also called a Fee-for-Service payment. Private pay obviously is when the client or the patient pays directly for the service. We have three main types of payers: self-pay which is also private pay, commercial payers such as our private health care plans, and government payers which are Medicare, Medicaid, and Tricare. So, the responses that you give and the responses that you receive may be inaccurate because of all of those variables. People frame their responses based on their own experiences and some of those experiences obviously differ depending on your payer sources, payment systems, and practice settings. If I ask ten different SLPs the same question about coding and payment for a particular procedure, I probably get 15 responses back. Let me tell you where the title for this course came from. Describe SLP supervision requirements with respect to multiple healthcare practice settings and payer sources.Define and differentiate payment systems and practice settings for Medicare Part A, Part B (aka Original Medicare), and Part C (Medicare Advantage Plans).Identify and contrast multiple payer sources for SLP services.Learning OutcomesĪfter this course, participants will be able to: The information on these webpages was developed by ASHA's Medicaid Committee and addresses key Medicaid issues related to audiology and speech-language pathology services.Editor's Note: This text is a transcript of the course, Payment for SLP Services: Navigating Payer Sources, Payment Systems, & Practice Settings, presented by Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow. State program plans are subject to review and approval by the federal Centers for Medicare and Medicaid Services (CMS). Each state then administers its own program and establishes its own income eligibility standards type, amount, duration, and scope of services covered and payment rates. The federal government establishes broad guidelines. Audiology and speech-language pathology services are recognized as covered services under the Medicaid program. The Medicaid program is jointly funded by the federal and state governments to assist states in providing medical care to low-income individuals and those who are categorized as medically needy. A Guide for Audiologists and Speech-Language Pathologists
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