Improving Coverage and Reimbursement Rates

You have accessThe ASHA Leader ArchiveBottom Line1 Apr 2004Improving Coverage and Reimbursement Rates Janet McCarty Janet McCarty Google Scholar https://doi.org/10.1044/leader.BML.09072004.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In ASHA continues to work on improving reimbursement for audiology and speech-language pathology services through its 2004 Focused Initiatives. Last year ASHA launched a comprehensive effort to help members access information and tools to negotiate appropriate coverage and payment for services-and to advocate for better coverage through legislative change. The total bill for the 2004 Focused Initiatives on health care reimbursement topped $83,000. The questions and answers that follow show how that money is being spent. Q: What efforts are underway to improve coverage and reimbursement rates? A: ASHA is working directly with representatives of Blue Cross and Blue Shield Plans, state Medicaid programs, Federal Employee Health Benefits plans, and consumer groups to raise awareness of coverage for services. A human resource consultant will be utilized to advise ASHA on the best ways to improve coverage, and a new ASHA Web page will assist employers, insurers, and union leaders with information on adding benefits. A document that discusses medical necessity and why speech-language treatment and audiology services are medically necessary to help an individual achieve a normal, healthy state will be developed. Also, look for a new "e-zine" or "e-newsletter" focused on payment and reimbursement issues in specific work settings, which will target payment information to the most appropriate groups. A database that tracks coverage and payment policies of health plans also will be expanded. Q: Medicaid rates are too low. What's being done to correct this? A: ASHA is creating a new document for state associations to use in negotiating better outpatient rates and to save speech, language, and hearing benefits in Medicaid programs. Actuarial data, Medicare rates, and selected Medicaid rates will be included in the document. Q: Can I participate in this reimbursement initiative? A: Yes, through your state association. A state-based reimbursement network, State Advocates for Reimbursement (STARs) was developed last year, and continues to grow as a resource for ASHA members. The STAR network will be active in initiating state campaigns for improved coverage. Ask your state association for information/contact person. Two telephone seminars (one with a Web enhancement) for up to 53 participants/lines will provide further reimbursement training for STARs, with an option for 32 replays. STARS also participate through bimonthly conference calls and interactive messages on a forum and e-mail discussion list. Q: Can coverage be legislated? A: State lobbying can make a significant difference in gaining coverage for services. ASHA is working with states to assist them in obtaining health plan coverage through state legislation. Model bills were developed in 2003 to build this effort. ASHA also will advocate for coverage at the National Conference of State Legislatures and the Council of State Governments. Q: What conferences or resources are available to help me with reimbursement? A: Seven half-day conferences conducted at ASHA Convention, the ASHA Health Care Conference, and five state association meetings will offer information on how to advocate and negotiate for private health plan coverage. Watch The ASHA Leader for updates on the reimbursement Focused Initiative, and associated products. Q: What role do consumers play? A: Consumers can access a new ASHA Web page designed to help them with the appeals process, and encourage them to become advocates for comprehensive coverage of speech, language, and hearing services. A media plan will be developed to increase awareness and to distribute ASHA's consumer-focused materials to groups such as the National Stuttering Foundation, the Alexander Graham Bell Association for the Deaf and Hard of Hearing, and Self Help for Hard of Hearing People. Author Notes Janet McCarty, is ASHA's private health plans advisor. Contact her by phone through the Action Center at 800-498-2071, ext. 4194, or by email at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 9Issue 7April 2004 Get Permissions Add to your Mendeley library History Published in print: Apr 1, 2004 Metrics Current downloads: 232 Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2004 American Speech-Language-Hearing AssociationLoading ...