Texas SLPs Score Insurance Victory

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You have accessThe ASHA LeaderASHA News1 Dec 2009Texas SLPs Score Insurance Victory Barbara Samfield andMA, CCC-SLP Gretchen BebbMA, CCC-SLP Barbara Samfield Google Scholar More articles by this author , MA, CCC-SLP and Gretchen Bebb Google Scholar More articles by this author , MA, CCC-SLP https://doi.org/10.1044/leader.AN1.14162009.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In The Texas Speech-Language-Hearing Association (TSHA) scored an unprecedented victory for the state’s private practice speech-language pathologists in October, when it challenged—and negotiated with—Blue Cross Blue Shield of Texas (BCBS/TX) to stop efforts to recoup payments going back three years. BCBS/TX attempted to recoup payment from private practitionersacross the state for the primary speech treatment code 92507, claiming overpayments for services billed. BCBS/TX stated that the code is an untimed unit that could not be billed in multiple units and sought the return of reimbursement for such billing. This effort could have forced many private practitioners into bankruptcy. This code is considered an “untimed” code by the Centers for Medicare and Medicaid Services. However, private practitioners offered evidence that BCBS/TX representatives had advised them to bill in multiple units as part of provider contract negotiations, advice that led many providers to accept the BCBS/TX fee schedule arrangements. The TSHA executive board rallied to the defense of its members and coordinated efforts with legal counsel Mark Hanna to meet with representatives of the insurer. Hanna reviewed numerous provider contracts, recoupment notices, and BCBS/TX notification policies and, with the TSHA Executive Board, designed an action plan based on common contractual elements, BCBS/TX policies, and other payers’ acceptance of time units. TSHA’s primary objectives were to stop the retroactive collection process, return any recouped monies to the providers, and obtain a 90-day notification about the change in 92507 reimbursement practices. In October, Hanna and several other TSHA leaders including Keri Gonzalez, vice president for professional services, presented TSHA’s case in a conference call with two BCBS/TX vice presidents. The carefully crafted dialogue began with introductions, a review of key issues, and discussion of selected points. A significant negotiation point was BCBS/TX’s discussions of multiple-unit billing during contract negotiations with practitioners. The final step was to ask BCBS/TX to halt the recoupment process, refund recouped monies, and give providers the required 90-day notification of the intent to pay 92507 as an untimed code. The amicable discussion ended humorously with one BCBS/TX executive commenting about the “articulate” communication skills of TSHA’s SLPs. Negotiation Success A few days later after the conference call, BCBS/TX agreed to TSHA’s requests, with only the 90-day notification date remaining undetermined. TSHA clearly scored a win for its private-practice members—and for all SLPs in the state who are BCBS/TX providers. TSHA stepped up to the plate and took an important stand for the profession. Although negotiations with BCBS/TX were successful, important issues remain. TSHA looks forward to continued dialogue with its private-practice clinicians and the insurers regarding coding and reimbursement issues. Author Notes Barbara Samfield, MA, CCC-SLP, is co-chair of the TSHA Private-Practice Issues Task Force. Contact her at [email protected]. Gretchen Bebb, MA, CCC-SLP, is chair of the TSHA Reimbursement Task Force. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 16December 2009 Get Permissions Add to your Mendeley library History Published in print: Dec 1, 2009 Metrics Downloaded 61 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...