Billing and Reimbursement 2024 ISHA Convention Presentation Highlights

Published in the April 2024 ISHA Voice.

By Lacey Peters, a member of the Billing and Reimbursement Committee.

Missed the Billing and Reimbursement Committee’s Presentation at ISHA?  Here is a brief recap of things that were discussed during that presentation.

• It is important to know and understand insurance-related terms such as: deductible, co-insurance, copay, prior authorization and visit limits so that you can determine the likelihood of covered services and explain coverages and expected out of pocket costs to your patients.   
• Exclusions for certain diagnoses are common, so ensure you are calling to check benefits (online systems often do not list exclusions, but only quote general benefits).  Ensure you ask about exclusions and have the insurance representative reference the plan documents to determine if there are any listed exclusions on the plan prior to services being rendered.
• CMS has approved new Caregiver Training Codes.  While these codes are billable, whether CMS or Private Insurance is paying these codes is not yet determined.  To determine how this code is defined and when it is appropriate to bill, reference the guidance from ASHA.
• New CPT codes have also been updated for Audiology in 2024.  See the following guidance from ASHA regarding these codes.
• Unsure of where to start when it comes to billing third party payors?  ASHA has a resource for CPT code billing and coding guidance.

If you have any questions, please reach out to the Billing and Reimbursement committee.

Lacey Peters, M.A. CCC-SLP holds a B.S. in Communication Sciences and Disorders from Northern Illinois University and a M. A. in Speech-Language Pathology from University of Illinois at Urbana-Champaign. Lacey is currently the Owner, President and Clinical Director of Midwest Speech Therapy in Bloomingdale, IL. Lacey is an active member of ISHA and has served as a member of the Billing and Reimbursement Committee since 2021.