PRIVATE PRACTICE

BCBSM Direct Billing:

Blue Cross Blue Shield of Michigan announced yesterday that in September, 2010, it will initiate a project to directly reimburse Speech-Language Pathologists.  The project is expected to be implemented in the fourth quarter of 2011. 

SLPs (and Occupational Therapists)  will be able to bill Blue Cross Blue Shield-Michigan directly, an option that has been available to Physical Therapy for many years.

This policy revision, long-sought by MSHA, was one of the objectives of the ASHA Reimbursement Grant MSHA received this year.  Members of the Grant Committee responsible for developing the Reimbursement objectives and strategies include:  Beverly Jaynes, Elaine Ledwon-Robinson, Rick Merson, Julie Pratt, Sherry Riedel and Tim Weise.   We express appreciation to all of you who responded to the ASHA Action Alert requesting letters of support directed to the administration of BCBS-Michigan as well as to our colleagues in Occupational Therapy who provided advice and support.

MESSA Billing:

Effective March 1st, SLPs will not be able to bill MESSA (a division of Blue Cross/Blue Shield of Michigan that insures primarily teachers),  for services unless there is a Doctor onsite or they are affiliated with a hospital. There will be a 6 month transition period where they can continue to see current patients, but cannot take any new ones.

MSHA is forming a coalition of individuals in private practice to deal with this issue.   If you would like to join this coalition, please leave contact information with the MSHA office or at 517.332.5691.

ASHA Reimbursement Advocacy Improvement Grant:

The Michigan Speech-Language-Heaering Association has been awarded a $4000.00 grant to address reimbursement issues in the state.  Congratulatons and thank you for the expertise and hard work of Elaine Ledwon-Robinso, Bev Jaynes, Tim Weise, Julie Pratt and Kathleen Baines.

SLPs in the State of Michigan are encountering significant barriers in providing services to patients with Blue Cross (BC) and Blue Care Network (BCN) insurance, secondary to documentation and physician visit requirements that delay initiation and completion of patient care.  This project proposes the following strategies to target the problems of excessive and inappropriate documentation requirements, unnecessary PCP return visits for the purposes of verifying participation in speech-language therapy and the inablility of patients referred by physicians to access their voice therapy benefits:

• Establish a coalition of SLPs, in consultation with an expert in governmental affairs, to review current documentation and physician visit requirements that act as barriers to or delay accessing SLP treatment.  The coalition will develop a proposal to improve and streamline documentation and physician certification of SLP treatment plans while meeting the needs of the insurer to document medical necessity.  The coalition will meet with leaders of BC and BCN to address these documentation and physician visit issues, with the goal of streamlining documentation, maintaining treatment quality and reducing the overall costs of providing service.
• Establish a liaison with the Michigan Physical Therapy and Michigan Occupational Therapy Associations and activate a coalition to address insurance documentation and reimbursement issues from the broad-based rehabilitation professionals' perspective.
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• Convene a meeting of SLP experts in voice disorders and, with the support of the Michigan Otolaryngology Society, request a meeting with BCN to discuss improving th status of medical/rehabilitation care for patients with documented voice disorders

We hope that through this grant MSHA leaders will be able to take actions that will lay processes that address the reimbursement issues with both short and long term sustainable effects.

MSHA will post updates on the progress of their work.  July updates are now available.