Speech & Hearing Therapy

[jyoung65]

Hello,

I have a meeting with a large speech and hearing practice. This would be a good contract, I want to get all the knowledge that I can, to acquire this contract. The prospect said a majority of their billing is Medicaid. Would like to know the routine cpt codes, that are billing for speech and hearing therapy and if auth is required for office visits. I have done some research and notice that 92627 is billed in 15 increments, how many increments are typically billed per visit for this code? Does all the speech and hearing codes require GN modifiers? What are the top denials for speech and hearing? Do speech and hearing use 99 or 98 codes or do they just use 925 and 926 codes?

Any question that I should ask the prospect about billing? Anything else I should know about speech and hearing billing?

Thanks in advance I appreciate any suggestions and feedback. 

[Michele]

92506-92508 are the most common speech therapy cpt codes.  The GN modifier would only be used on Medicare, unless your state Medicaid also requires it.  NY does not.  I do not believe that you would use the E&M codes for this.

Hope that helps.

[jyoung65]

Do you charge percentage or flat fee for speech and hearing billing? Thank you for your feedback!

[Michele]

Well that would depend on what state you are in since % billing is illegal is some.  But quite honestly % billing is not the most desired way to charge.  You really do not always get paid for all of your work and your income can fluctuate greatly when in actuality your work remains the same. 

[jyoung65]

I shopped my competitors and they are charging a percentage, and they may be one of the medical billing  companies, that will be meeting with the same practice. Shouldn't I be competitive with the other billing companies? I agree percentage is not profitable with some providers, when providers have a low reimbursement. My competitors make it tough when they charge a percentage for all providers. I could not believe that they also charge the same percentage for old AR. The client that I have now I charge 40% for all old AR and my competitor charge 7%, which is killing me, it is some much work involved and to charge 7% is like working for free. Thanks     

[PMRNC]

I don't worry about what my competition is doing. I know that might not be what you want to hear but it's true. I work off my reputation, if a client is shopping, they are going to shop, nothing I can do about it except let my name and my reputation and work stand on it's own merit's. Yes, I have lost clients to competitors, but I've also been called later on to clean up the messes as well. I've had doctors tell me that XX company charges _% and I'm in NY so I tell them that entering into that contract would put them at risk since it's illegal here.. they always love that one.. not.   My point is, If I know they are shopping, I don't change the way I do business, I'm worth the money I charge and all work I put in.

[Michele]

Linda's advice is right on the mark.  Here are a couple of other points.  I always tell drs that say "so and so only charges xx%"  -  "you get what you pay for.  X% of a lower amount of money is < than my % of a greater amount of $"  I, like Linda, stand on my performance and my reputation.  There are unfortunately a lot of providers out there that shop based only on price.  I don't want them.  If they want me because I'm the cheapest, they want me for the wrong reasons.

Another one is "bottom line, charging a % in NY is illegal, considered fee splitting, and you, the provider is the one who gets in trouble.  Look it up, ask the local Medical Society.  They will confirm that a % is fee splitting.

[PMRNC]

Another one is "bottom line, charging a % in NY is illegal, considered fee splitting, and you, the provider is the one who gets in trouble.  Look it up, ask the local Medical Society.  They will confirm that a % is fee splitting.

It really is ONLY a matter of time where this will be completely abolished everywhere.. the OIG has been harping on this for years and with cutbacks and increased efforts to control fraud and waste, the % based pricing model is DOOMED and going with that now IMHO is a big mistake because it can be very difficult to transition to another method.   I won't have this argument on the legalities in NY or any other state where it is illegal because it's futile, I simply refer them to a few attorney's to back up the information and that's it.  It's a POOR model of pricing all around. It creates the illusion that the biller will work harder..thereby increasing chances and the illusion of fraud. It also demeans the experience of a good billing company because it states "I don't' get paid until you get paid. Imagine your tax professional that said "I won't get paid unless you get paid" LOL.     I think too many billers are too focused on the fact that "Well, every other company charges a percentage".  I have to go back to what mom said when we were little, "If everyone were jumping off the bridge, would you also jump?  When you charge what you believe your worth and for your time and expertise, this confidence shows to the provider. Yes maybe you will lose to the company that advertises 4% (yes such a company exists) but in most cases, you'll be talking to them again in the future.   Don't worry about what your competition is charging and instead focus on the services your competition is NOT providing that you can offer. That is where you will win.

[jyoung65]

Good advise, I really appreciate your feedback!  Thanks