Author Topic: speech therapy - communication device  (Read 1662 times)

Anne

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speech therapy - communication device
« on: September 05, 2009, 08:58:34 PM »
I just started billing for a Speech Therapist.  (Other clients I have are PT and OT).  The ST asked me to prepare a claim for one of her patients and file her primary ins. for a "communication device".  She said they'll deny, but then we can file Medicaid and they will pay.  I asked her the name of the communication device and she hasn't answered me yet.  I've been reading about communication devices but don't see anything about billing for.  I'm not familiar w/ DME codes, I'm assuming I'll need to use DME code for that claim.  I don't want to say that I haven't done it before.  But the truth is, I'm not so sure what I need to do for this claim.  Do communication devices have codes?  Do I use that in place of CPT code?  dumb question, I know. 

Steve Verno CMBS, CEMCS

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Re: speech therapy - communication device
« Reply #1 on: September 05, 2009, 09:24:34 PM »
YOU must wait to hear from your ST regarding the specific communication device as there are many to choose from.  Each one has its own HCPCS code.  BEFORE YOU DO ANYTHING. you should check both the personal health insurance and MEDICAID to see if the device is a covered service and payable.  YOU should also find out of your ST is enrolled with your Medicaid.  If not, then all your work may be for nothing.

Some info is here:
http://websrvr.dmas.virginia.gov/manuals/DME/app_b_Commun_Devices.pdf

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PMRNC

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Re: speech therapy - communication device
« Reply #2 on: September 05, 2009, 09:39:21 PM »
Also.. I have to ask...who is the primary carrier?  If they have primary insurance.. why the Medicaid?  ??? ??? ???
Linda Walker
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Anne

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Re: speech therapy - communication device
« Reply #3 on: September 05, 2009, 09:48:54 PM »
patient has United Healthcare as primary ins. and Medicaid secondary.  and yes, provider is a Medicaid provider.  I was definitely going to wait until she told me what specific device she was talking about and will check w/ patient primary ins. and we will have to get auth from Medicaid.  will tell you more when I know.  thanks for your quick reponse.

Anne

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Re: speech therapy - communication device
« Reply #4 on: September 05, 2009, 11:31:58 PM »
ST says commucication device is Toby with eye gaze (cost is $13,000) Do you know about that? 

PMRNC

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Re: speech therapy - communication device
« Reply #5 on: September 06, 2009, 10:14:25 AM »
Quote
She said they'll deny, but then we can file Medicaid and they will pay.

If UHC denies the device for Medical necessity you will have to FIRST appeal and exhaust efforts with them FIRST.. Medicaid will NOT pay or even consider payment if the primary denies for Medical Necessity. You will have to prove Medical Necessity with the primary first.. same with authorization, you must follow and exhaust efforts with primary payor first. If you don't obtain an auth and they deny for auth you will have to then appeal with UHC. Medicaid will be the payor of last resort and only if all procedures are followed for consideration of the claim by the primary payor.
Like Steve mentioned, there are various HCPCS codes, and this will be a DME Code. I would say your best resource for this is to go to the manufacturer for the proper code. 
Linda Walker
Practice Managers Resource & Networking Community
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Anne

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Re: speech therapy - communication device
« Reply #6 on: September 06, 2009, 11:57:34 AM »
yes, I planned to send in doc. to show medical necessity w/ prim. ins claim.  evidently ST has done this before and thinks it will be denied by United, but maybe it wasn't done properly before.  Not sure why she said United would deny.  And not sure why Medicaid would pay.  I was assuming she must have had some past experience w/ billing for this particular device.  thanks for tip about checking w/ the manufacturer - I didn't think of that.