Fix SLP: Advocacy & Accountability in Speech-Language Pathology

The new Medicare speech therapy CPT codes are coming, and adult SLPs need to prepare.

In this episode, Jeanette Benigas, PhD/SLP, is joined by Katie Brown, SLP of Neuro Speech Solutions (@neurospeechsolutions), to discuss how the new code family replacing 92507 could impact adult speech-language pathology across Medicare Part B, skilled nursing, outpatient, home health, hospital outpatient, and private practice.

They discuss how the new codes may affect reimbursement, scheduling, productivity, documentation, cognition treatment, Medicare Advantage, commercial insurance, and ethical billing. They also explore why accurate utilization data will be critical to future advocacy for higher reimbursement rates.

Whether you own a private practice, work in a SNF, outpatient clinic, hospital, or even pediatrics, this conversation will help you understand what's changing, what questions remain unanswered, and how to start preparing now.

Topics include:
• The new adult SLP CPT codes
• Replacing 92507
• Medicare Part B billing
• Cognition reimbursement
• Documentation changes
• Productivity concerns
• Private practice and SNF implications
• Ethical billing and future advocacy

Resources Mentioned
👀 Check out Katie's SLPs Blueprint to Medicare Success and get $100 off with the code FixSLP
🎧 Previous episode: CMS's NEW Pediatric G Code Explained: What Every SLP Needs to Know
🎧 Previous episode: New York Early Intervention in Crisis
🎧 Previous episode with Katie Brown: Telehealth Coverage Expired: SLP Rules for Medicare Claims
🎧 Previous episode with Katie Brown: Telehealth Under Threat: Protecting Access for Adults and Families
▶️ Watch the Fixing the Coding Chaos series, or this episode on YouTube

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Creators and Guests

Host
Jeanette Benigas, PhD/SLP
Host of Fix SLP

What is Fix SLP: Advocacy & Accountability in Speech-Language Pathology?

Fix SLP is an SLP Podcast by Jeanette Benigas, PhD, about advocacy, autonomy, and reform in Speech-Language Pathology. This show exposes credentialing gatekeeping, dismantles CCC requirements, and helps SLPs advocate for change. Each episode equips SLPs with tools to reclaim their profession. Subscribe now and join the movement transforming speech-language pathology. Follow @fix.slp on Instagram and TikTok. Visit fixslp.com.

Jeanett Benigas:

This is gonna be a rough I might not even cut any of this out so you all can see I'm on the freaking struggle bus. Take nine.

Katie Brown:

You've got a lot on your plate right now.

Jeanett Benigas:

Take 47. Welcome to FixSLP, the podcast shaking up the field of speech language pathology. We're calling out the barriers that hold clinicians back, fixing broken systems that limit our care, and giving the power of our profession back to the people who live it every day. This is where fearless clinicians come together. It's time to change the field with our voices, leadership, and advocacy leading the way.

Jeanett Benigas:

This week, we are talking about the 10 new codes and how they apply to adult therapy. I have asked a fan favorite, Katie Brown from Neuro Speech Solutions to come and talk. Katie, I know that we're going to have a pretty intense and what I imagine long episode. So everyone, please stick through this with us because the timeline's important. Again, it might get long, but there are a lot of things to know.

Jeanett Benigas:

Think about including a new code set that no one's talking about. Okay, you're going to hear it here first, but I don't want people to tune you out. So Katie, tell us who you are and then we usually do this at the end, but give us your handles where people can find you. You've got a course. You have long since shared a promo code with our Fixers, so share that again.

Jeanett Benigas:

Tell us.

Katie Brown:

All right. Awesome. Well, thank you for the introduction, and thanks for having me back again. Always great being on the FixSLP podcast. So like Jeanette said, I am an SLP based in Buffalo, New York, I own a private practice.

Katie Brown:

My private practice has been open for seven years. I have a much larger practice today than I did before. I have many employees now, and I have certainly been watching out for these coding changes as things have been rolling out. I wanted to see how it shook out. I also help to educate private practitioners on Medicare Part B policy.

Katie Brown:

I have a program called Medicare for SLPs. It is essentially a step by step course that helps speech pathologists understand Medicare without getting lost or confused or looking at misinformation online. I teach you how to enroll, document, bill, stay compliant, everything like that, so that way you can serve your patients and build a sustainable practice. I will also be updating the course drastically come in January. Is a promo code for FixSLP, which I believe is just FixSLP.

Jeanett Benigas:

Should people wait till January if you're going to be changing it? Or is it something they should watch now? Then do they have to buy it again in January? How does that work?

Katie Brown:

I think that you should absolutely purchase it now if that is the stage that you're in for private practice. Any updates that I make to the course are always you get lifetime access to them. So when I change the course and I invest more time in it, I don't know. The price might go up. I can't predict that right now.

Katie Brown:

But if you signed up now, you would get it at the price that the program is now.

Jeanett Benigas:

You shared that with us a while ago. I'll even link up your old episode. Like, we've done some work together already. Like, it has been awesome.

Katie Brown:

This is my third time on FixSLP.

Jeanett Benigas:

Gosh. It's like you and Rizkawenda are our frequent flyers here. Yeah. So we've done some CMS advocating together. We've collaborated before with you really leading the way and me just getting your voice heard.

Jeanett Benigas:

I'll link those up in the show notes with a couple others that we'll end up talking about. So please support Katie, but she is a private practice owner, so obviously they're doing Part B. That's who this applies to. All of our friends in home health, Part A Medicare in SNF, and then acute do things a little differently. So these new codes don't necessarily apply in terms of reimbursement.

Jeanett Benigas:

However, probably the way you bill will have to change. Medicare's not going to do away with 92,507 for Part B in a nursing home, but still have you bill 92,507 for Part A, right? So the codes in skilled nursing are going to change. It's a different code set in acute, but there will likely be a trickle down effect. We're going to see this widespread.

Jeanett Benigas:

It might not be immediate, but it's coming. I'm tired of reading on social media that this doesn't apply to me because I work in X, Y, or Z sweat. Okay. It doesn't matter what setting you work in, it is eventually going to apply to all of us, and it is going to, I think, and I think Katie thinks too, but we'll see, deeply impact our ability to make money. And I have been saying this from the beginning.

Jeanett Benigas:

Since February, the very first conversation I had with my collaborators on this topic, I was concerned, especially for those in skilled nursing. Now, our private practice friends, God bless them, blew this up. They got us where we are right now, but it was a lot of pediatric private practices very concerned. I wasn't hearing a lot from our med SLPs in SNF or our private practice adult owners. I think there's just less of them too in terms of private practice, but our SNF friends should have been screaming.

Jeanett Benigas:

So here we are. This is happening. It is not what if, it is happening. And so if this is the first you've heard of it, you're gonna need to go back and listen to a couple podcast episodes about what has happened to ninety two thousand five hundred seven. It is gone.

Jeanett Benigas:

January 1, it is being replaced with five base codes and five add on codes. There is a G code proposed for pediatrics only, so that does not apply to our population and we will not be discussing that today. This discussion is still good for our peds people to listen to because there may be some things to think about here, but largely this is adult and what we need to be concerned about moving forward. So we all need to be putting in comments and hopefully by now everyone has seen the video that I recorded and put on social, but we do have a plan. And so our general plan is number one, we have all recognized on our little team that we don't know what we're talking about in terms of getting CMS to change rates or adopt codes during the rulemaking period, which is where we are right now.

Jeanett Benigas:

They gave sixty days to collect data and take comments. We could use AI and make stuff up and hope for the best. However, we want to serve people well. I have sustaining partnership money that is how the business expenses of fixed SLP are covered. I do not take a salary or pay myself from that pot of money.

Jeanett Benigas:

I have been using it until February to pay expensive lawyers. However, once all of this started, I put legal talk on hold and haven't met with lawyers and so I've just been squirrelling that money away. So I have a small pot of money that hasn't been spent that I am going to dedicate to hire either a consultant who knows how to successfully get through this process or a lobbyist or a former CMS person who advises, we are looking into that. I am leaving for vacation in twelve and a half hours in the middle of the night, 3AM, okay? So I have or not I, I'm not directing this.

Jeanett Benigas:

There are two other people working on actively making phone calls, getting rates because lobbyists can be anywhere from like 4,000 a month to $25,000 a month. So we're asking questions like, can you advise us appropriately? If this isn't successful, can we take you beyond this stage? Do you have receipts and a track record of being successful? You know, we're asking a lot of questions and how much is this going to cost because what I have in the pot is limited and we may need to come to all of you for some fundraising money.

Jeanett Benigas:

So that's where we're at. Again, we are not despite what maybe you have heard on social media, we are not saying don't comment during this comment period, neither is AAPP SBA that is the membership association for private practice owners, neither of us have said that. PhDSLP has said, please wait. Wait until we gather more information. And so now we are seeking wise counsel and we will get the best information possible on how to utilize this comment period effectively.

Jeanett Benigas:

So please continue to stay tuned. We fully realize we are up against the clock here. We're working quickly, but we spend money wisely. We don't just want to pick the first person off the street. So we're asking a lot of questions, taking meetings, doing interviews.

Jeanett Benigas:

I'm going to be on vacation for a week, so it might be a little slower than I would have liked, but we will get this done quick. Okay? Now, next week, we're gonna talk about auditing risks and documentation. Katie's gonna come back to talk more about that and Emily is going to come back as the peds voice to talk more about that. And I also have a school's application coming as well.

Jeanett Benigas:

I am hoping to record all of that next week on vacation. So you'll be hearing this. Hopefully, I'm laying on the beach and not working. But we're gonna record that on vacation. I'm planning to edit on the drive back so then you should hear it one week from today if you're listening to this at the drop.

Jeanett Benigas:

Okay, Katie. We're already like eight minutes into this.

Katie Brown:

Let's go. There's a lot

Jeanett Benigas:

of fire here.

Katie Brown:

Which So, has we served us well.

Jeanett Benigas:

Uh-huh. The codes are happening. We've got these new codes. We're not going to go through the whole thing. People can go back and listen.

Jeanett Benigas:

Yes. We've said this is Medicare Part B outpatient, SNF Part B, hospital outpatient. So I said hospital, but that's acute, not acute, but hospital outpatient, and any private practice that bills Medicare, which would include the pediatric Medicare recipients, which is probably less than one percent of all Medicare recipients. I tried to get a percentage. Couldn't find it anywhere.

Jeanett Benigas:

Even AI didn't know it when I went to look there. That ped population could end up with the G code depending on what they do. Again, that's not our purpose today. So it's not automatically changing Medicaid, commercial insurance, workers' compensation, VA, or any Medicare Advantage plan, which could make this even more complicated. Okay?

Katie Brown:

Absolutely. What go ahead. The administrative the administrative nightmare that this is going to cause across the board in every single setting is immense. I'm already my wheels are turning the second that the proposed rates came out. I immediately started plugging them in, figuring out my geographical index conversion rate.

Katie Brown:

What does this mean? What percentage am I potentially losing? And if any private practice owners aren't doing that right now, it's something you should absolutely be doing, because we need to make decisions. Before, we just had this nice code where you could do anything you wanted and see them for however long you wanted, and it was very predictable. We knew exactly how much we were going to make.

Katie Brown:

Now there's a lot of contingencies on this, and there is an opportunity to potentially make some more money for certain patients. However, there is also a real good chance of taking a cut depending on which patients you're seeing and a lot of other factors that are out of our control.

Jeanett Benigas:

On average, Katie, how long are you seeing patients in your practice?

Katie Brown:

On average, we see patients for about forty minutes, which is why I had kind of I stepped back and was like, Okay, I can absolutely see how this is going to be detrimental to pediatric private practices who typically see kids for thirty minutes each for a number of different reasons. And I knew that I would be able to potentially bill a base code, so I was kind of holding on and saying, Okay, well, let's see how this shakes out. And it shook out. It shook out, I don't know, kind of a mixed bag, I guess. There are a few instances where we're probably going to lose money.

Katie Brown:

There is a very good opportunity for any speech and language combo codes. But again, we'll talk more about this in the auditing one, just because we can make more money with the speech and language combo code doesn't mean we can bill it for every patient. This is very important. So that's where I say it's kind of a mixed bag for MetSLP unless you've been seeing patients for thirty minutes, in which case this is not good.

Jeanett Benigas:

Yeah. So scheduling in a private practice like yours is going to be okay because we've already talked on this podcast, and I have a whole entire series called Fixing the Coding Chaos on YouTube. Posted content on Facebook, and then I turned them all into videos. And so you could go to the FixSLP YouTube. Please subscribe.

Jeanett Benigas:

I mean, I've always said I wanna find other ways to monetize this so I can get paid. And I've heard YouTube pays some money. I don't yet know how to make that, and I'm not

Katie Brown:

gonna You haven't start seen any of it yet.

Jeanett Benigas:

I'm not gonna start selling lip gloss. I can assure everyone of that. But I do I'm not dumb. I do know there's probably a subscriber minimum and things like that. So please subscribe even if you're not gonna watch.

Jeanett Benigas:

But maybe go subscribe, watch a couple minutes, throw me some hours. Is. Wait, what do they say? Smash that like button? I don't know.

Katie Brown:

Yeah. Smash the subscribe button.

Jeanett Benigas:

Yeah. So you can go look at a whole explanation of how these codes can be built over on YouTube with I think most of the videos are around five minutes, some are less, some are a little more. But I talk about how they can be combined. But basically, there are five parent codes, thirty minutes each, and they each have a child, an add on code. So you can't use an add on.

Jeanett Benigas:

You can't mix families. The parent and the add on stay together. So you can't do, like, voice parent and language add on. It can only be voice parent, voice child. Okay?

Jeanett Benigas:

So that complicates things a little bit. Because of the 50% plus one rule, we have to bill that base code at sixteen minutes minimum. You can't add the child unless you bill the entire thirty minutes. So we're looking at some time differences, which could cause some scheduling issues. But really, at a forty minute practice, if you're using, let's just say you're treating all language, you can do a thirty minute base of language and a fifteen minute add on, which can then be 50% plus one, eight minutes.

Jeanett Benigas:

Then you have a thirty eight minute session, and there's your forty minutes. With two codes, so maybe you want to do voice and fluency, you can use both of those parent codes together. 50% plus one, sixteen minutes and sixteen minutes comes to a thirty two minute session. So you certainly can, you know, do, like, twenty minutes in twenty minutes, which makes the 40. Mhmm.

Jeanett Benigas:

But, like, to max money, you do. Right? We're gonna have employers really taking advantage of this, I think, in the sniff setting. But it'll be, you know, a thirty two minute session minimum is how you'll maximize the dollar. So there's going to be, you know, we talked about this with Emily and Rick in the last session, you could be facing, I mean, you could just keep everyone at 40.

Jeanett Benigas:

But you also could be, or some practices depending on how you work, you could be looking at some scheduling issues, because how do you schedule out those windows?

Katie Brown:

Yeah. Mean, I do think that scheduling is going to impact my practice and every other practice because, yes, in theory, we have forty minute slots, and that's case by case dependent. Sometimes we see patients for longer, sometimes for less. It just depends on what they need. However, that is if everyone shows up on time and leaves on time and everything runs smoothly, which is absolutely not going to happen.

Katie Brown:

We're recording this on a Friday, which is the slowest day in my clinic. I have some clinicians that don't work on Fridays, some that work half days on Fridays. And I've been working the front desk today because my admin is out. It's 2PM. We've had five patients come more than five minutes late, which immediately takes us out of being able to build add on codes.

Katie Brown:

So, in theory, this is excellent. No issues. Right? No notes. But in practice, it's not quite that way.

Jeanett Benigas:

And here's another problem that I think a lot of non practice owners, like people who aren't directly involved in billing or pediatric SLPs or school SLPs don't understand. Number one, it is illegal to collect cash from someone who is a Medicare recipient age. It doesn't even matter if they don't have Medicare. Almost positive. The law says if they are of Medicare recipient age and you are providing reimbursable service, you can't collect cash.

Jeanett Benigas:

And that includes, for some of this, a late fee. Right? Can you charge a late fee on traditional Medicare?

Katie Brown:

If it's traditional Medicare and there is no Medicaid, yes, you can collect a late fee. As soon as someone has a Medicaid as secondary, you cannot collect.

Jeanett Benigas:

What about Advantage Plans?

Katie Brown:

Advantage plans, you'd have to look at your contract. Yeah.

Jeanett Benigas:

Yeah. So Yeah. You can't recoup sometimes some of this money with a late fee. Yeah. And also, there's another piece in this mix and it's something a lot of SLPs haven't heard of because we don't really use it to this point because we've just had one code and it's the MPPR and that stands for Multiple Procedure Payment Reduction.

Jeanett Benigas:

OTs and PTs have been dealing with this for years. I believe there is some legislation to do away with it but I don't think it has been passed yet. We'll be keeping a careful eye on that if we can get involved with advocacy for that once we get through this. You better believe we'll get involved if we can. Maybe that's even something like if we're hiring someone, maybe we need to ask that to the question list.

Jeanett Benigas:

Where's it at in progress? Is that something we could be contributing to? But what that says is, I have it right in front of me pulled up. This is an adjustment to the practice expense. It's an adjustment that a policy uses to reduce payment.

Jeanett Benigas:

They will pay 100% for the highest valued procedure. So right now, our highest value procedure is our combo speech and language code. So they would pay if, so let's say we're going to do sixteen minutes of that and sixteen minutes of voice for a thirty two minute session. It will pay 100% of the speech and language code. Then it cuts the practice expense payment for subsequent procedures or units up to 50% when done on the same patient in the same day.

Jeanett Benigas:

So that means if we are doing speech and language and voice, the voice practice expense would be cut by up to 50%, reducing the reimbursement that we make in those thirty two minutes.

Katie Brown:

Yes. Which equals out to be, I mean, depending on what code you're billing, it could be $20 taken off the top, you know, dollars 10 taken off the top. Regardless, it's a pretty large number.

Jeanett Benigas:

Katie, is this Medicare only or is this Medicaid? Is this private insurance? Who's using this?

Katie Brown:

It is absolutely CMS is doing it. So Medicare is absolutely doing it. And then it really depends on the commercial insurance company if they have adopted it or not. I know that UnitedHealthcare does. And then I can tell you that looking at my contracts and my reimbursements with insurance companies in my area, about 50% of them do and about 50% of them don't.

Katie Brown:

So there is a good chance that MPPR will, in some way, affect you. You're going to have to reach out to your specific payers to ask if that's the case. MPPR is not new. It's something, like you said, that has been going on for a long time. If you ever build speech and swallowing in one day, you'll see that MPPR.

Katie Brown:

Now it'll just be the same except with our new five parent codes because the add on codes are not MPPR.

Jeanett Benigas:

So that makes, if you're a business owner, it makes projections really difficult. If you are an employee, either in a skilled nursing facility, outpatient somewhere, please start to understand what your employer is facing. And I've been saying this all along, I think Katie here, very ethical business owner, is going to do the right thing, but she is not going to lose money, she has to keep the doors open. So she knows what the bottom line is to keep her clinic open, she knows what she has to make to keep her family afloat, right? And there's probably many private practice owners who aren't going to say, well, I'm not taking a cut.

Jeanett Benigas:

I'm going to transfer all of that onto you. Katie might end up taking a personal cut, but some of it will have to go to employees as well To the tune of reduced benefits, like maybe they cut your contribution to your four zero one ks. We've seen that before in the 2008, 2009 era. There were a lot of contract therapy companies reducing or eliminating contribution to 401ks, to retirement plans. There were a lot of companies in that era eliminating or reducing what they were paying into healthcare plans, so healthcare expenses went up.

Jeanett Benigas:

So that's another way that they can recoup money. They can up productivity. Listen, if they do that, please go revisit our podcast about how employers steal money from you because that is a way. Because you end up working off the clock, which is not acceptable. That's called wage theft.

Jeanett Benigas:

There is a word for that. And companies are losing lawsuits from everyone that has been reported to me and there's a whole podcast on it, anything at 87% or higher, companies are losing lawsuits to their employees and owe them money. So if your company puts you over 87% immediately, your entire team needs to start doing work audits every day. Don't work off the clock. Stay on the clock.

Jeanett Benigas:

Audit your work. That way you have a record, and if you get hit or you lose your job or whatever, you have a record, and you can take a class action and win it. So, track of that. If they bump you over 80%, it's game on. The ball's in your court now to make the change and get your money.

Jeanett Benigas:

But I think they'll go sneakier ways first because these lawsuits are actively happening. I've heard from dozens of people who are getting thousands of dollars out of these lawsuits who can't talk about it because they're not allowed to disclose as part of the settlement. They

Katie Brown:

have an NDA.

Jeanett Benigas:

They've disclosed to me because what people tell me is private, and I do keep it to myself unless I have permission, but there have been dozens of people that I've heard from. So those are some ways, or they're just going to hunt what they pay us. And I think private practice owners are in a better position to manage some of that. It's when we get to the skilled nursing facilities that I have the most concern for. And that is because we all know a lot of us have been treating for fifteen minutes, for twenty minutes, Part B, right?

Jeanett Benigas:

And heard from one private practice owner in particular, Well, is what you guys were asking for. Like, you wanted time codes. You wanted to be able to see patients longer. Now you got what you wanted. No.

Jeanett Benigas:

This is not what we wanted. This is not even remotely close to what we wanted. And by the way, there were some influencers out there that I was calling out through the whole AMA process who were like, This is a good thing. They're not talking now. I've seen no posts on this.

Jeanett Benigas:

Okay? If your employer was paying you for fifteen or twenty minutes, in many cases, is going to have to be a forty five ish minute treatment to break even.

Katie Brown:

Yeah. I I am very curious what the average SLP, what their treatment lengths are in skilled nursing. I think that would be really fascinating to hear from some skilled nursing SLPs. Are you treating for fifteen minutes? Are you treating for forty five minutes?

Katie Brown:

Where are you? I know when I was in skilled nursing, I was treating for thirty minutes. That was, I mean, at this point, almost ten years ago.

Jeanett Benigas:

I

Katie Brown:

imagine it's probably just gotten less and less.

Jeanett Benigas:

So yes, we get to see the patient longer to get to forty five minutes. However, if you were treating for fifteen minutes, now your sniff has to pay you for that additional thirty minutes of time. So there is labor there that they have to find money to pay you. They're going to make the same that they were making at fifteen minutes, but now they need to do forty five or whatever it is. And I'm telling you, we are going to take a hit.

Jeanett Benigas:

And I don't know what that's going to look like, but it's coming. Look at the numbers. I don't have these reimbursements pulled up in front of me, but I've got a lot of concerns because we've got reduced rates, we've got these MPPR issues now coming in, and then what we don't even know about yet, and we talked about in the last podcast, but just in case our adult people didn't listen, we also have NCCI edits. Yes. And those are automated billing rules created by Medicare and Medicaid to stop improper payment.

Jeanett Benigas:

So in the past, adults have not been able to bill 92,507 and cognition.

Katie Brown:

True.

Jeanett Benigas:

Okay, so that was an NCCI edit. I brought this up on the last podcast. A modified barium swallow study with speech and a barium study with GI can't be billed in the same day. That's an NCCI edit. So, we don't know what that's gonna look like.

Jeanett Benigas:

Are we going to be able to build a cognitive code that's out there with some of these other things now? ASHA has said in some preliminary meetings that we had with them, they don't expect the dysphagia code to be impacted at all in terms of edits. We don't know, and we're not going to know until October.

Katie Brown:

Yeah. I think that's the other thing is there is not enough time to make these changes if you're a private practice owner. If you're an SLP in general, we keep getting these little drips of information, and it's proposed, and maybe. But whether it's two months or a month, it is not a lot of time to make big decisions. It's a real challenge.

Katie Brown:

I've been very stressed over here as a private practice owner.

Jeanett Benigas:

EMRs are used to doing stuff like this. So these EMR companies are going to be able to do some of this. There are some more issues in the pediatric world because of that potential G code that hasn't been adopted yet. But for adults, I think it's going to be a pretty clean transition in the EMRs because

Katie Brown:

Hopefully. Yeah. Yeah. Hopefully. As long as the EMR knows what's going on, they should be able to because there are plenty of professions that do timed codes.

Jeanett Benigas:

Mhmm.

Katie Brown:

So they can just model it out off of that. If you're in a more, I don't know, a more niche EMR, it might be a little bit more challenging.

Jeanett Benigas:

I think the big ones like simple practice, which, by the way, I'm gonna drop this right here because this happened in the last few months, and I posted about it because I am drowning. A bunch of private practice owners came together after the AMA meeting when they saw what went on in that meeting, and they began writing to Simple Practice. If they were using Simple Practice, they said, You know what? We're not going to use you anymore because you are a corporate sponsor of ASHA. Corporate sponsorship starts at $50,000 then there's like a $100,000 package, 150, and custom.

Jeanett Benigas:

So it could be through the roof. We don't know what those are. Those aren't disclosed. We just know what the packages are that are made public. But, man, did they pummel Simple Practice, and it was Simple super Practice pulled their their corporate sponsorship.

Katie Brown:

Seriously, I am so impressed and pleased with Simple Practice for actually listening to, seriously, for listening to their users and saying, If you continue to support this organization that is not actually supporting our best interests, we'll find another EMR in

Jeanett Benigas:

Simple Practice. If you want to send us a promo code, let's talk, teamfixslp dot com. My name's Jeanette. I'll get you in here. But also, you can advertise, okay?

Jeanett Benigas:

Simple Practice, hi. Practice, This is not a sponsored comment, but man, if you are looking in this process for a new EMR, I'm pretty sure an EMR like Simple Practice is going to be ready to go. Like you said, those smaller ones, more niche, privately owned, we love those guys, but it might be a little harder. Simple Practice serves many more disciplines. Know, PT is changing things all the time, so there will be some that will be ready.

Jeanett Benigas:

There will be some that maybe lag.

Katie Brown:

My EMR has already started putting out free webinars too about the SLP code changes, which is really nice. There are definitely EMRs out there that are going to be ready to go and going to support you along the way. If only we had endless amounts of that support.

Jeanett Benigas:

The biggest concern here is that sometimes you can't teach an old dog new tricks, and I think in this case, you're also not going to be able to teach some of the puppies new tricks either. There are a lot of us who have been documenting a very specific way for a very long time. The bigger issue here is that we are going to have to change how we document, how we interact with that EMR, the EMR use, the documentation expectations, all of this is going to change. And again, if you're in a hospital and your hospital is changing their EMR for outpatient B, the likelihood that your entire EMR is changing is high. It just is.

Jeanett Benigas:

Schools might be a little different, and again, we'll deal with that beast in a different episode. But I've been in practice for twenty years. I still do PRN in nursing homes. I'm going to have to learn this. Here's the thing: I am not working for a SNF right now because my fees company is exploding.

Jeanett Benigas:

My competition went bankrupt, left Ohio. I've taken on 18 new nursing homes in the last three weeks. Can't stay above water, okay? I had to hire someone. I never thought I would hire an employee, but here we are and I'm thinking about hiring a second person.

Jeanett Benigas:

I don't know when I'm going to get trained on this. This thing is going to shift and these companies are going to put out all of this education and they're not going to pay me right now, at least I don't think they are. In fact, this is a good business move. Maybe I should contact one of them and say, Hey, I know you're going be training your SLPs. Do you want me to come in and pay me for those trainings so I'm ready to go when you need me?

Jeanett Benigas:

Get a few hours on the clock there, but if you're PRN only or you're occasional PRN in some of these places, you better make sure you get that training because next July when you get called when Sally Anne is going on vacation, you're going to have missed the training and you're going to be expected to just show up and document. So these are like issues I'm thinking about because I know this world so intimately. SLP for twenty years, seventeen in skilled nursing, hospital and home health. I've never stopped working and I know how hard it is to get people to change just dysphasia practices based on research. Like, this is how I've always done it.

Jeanett Benigas:

We're going to keep you can't this is how I've always done it with this documentation. Or there's going to be money that is going to have to be paid back. So again, we'll talk about that next Let's talk about some good news. Now, what this is going to allow for is more specificity. And I think this can be a problem.

Jeanett Benigas:

We'll talk about it with the auditing. I just told a brand new little baby SLP straight into her CF the other day. You have to know why you're picking a patient up, and know what you're doing, know what the functional decline was, so you know what you're helping the person with. And that will drive your treatment decisions. That will drive the modalities that you choose.

Jeanett Benigas:

And so if you're good at that, which systemic issues, you all know how I feel about academia. A lot of you out there don't know how to do that, because she looked at me like a dog in headlights. I said, You've never done And this before, have she's like, No. But if we can get good at this, and it's okay to say, I'm not good at this. I need to improve.

Jeanett Benigas:

Like if I was treating a voice patient, I would not know why I'm picking people up and how to do the things. But cognition, girl, that's the other part of my PhD. I got you. Call me. Call me.

Jeanett Benigas:

I'll tell you how to do that. But I think it's going to allow for very good documentation of what we do and why we do it. And we always say, Nobody knows what we do. And I even say, Sometimes including us, SLPs don't even know what they do sometimes. This is going to force us to learn what we do.

Jeanett Benigas:

And I think that specificity is going to take us a long way in gaining respect, in showing outcomes in specific areas. I think gone are some of these crap modalities that don't produce results because of these auditing issues that could come up. I think we can get better at our jobs with this type of specificity with these new codes. What do you think, Katie?

Katie Brown:

I think that I agree with you. It's definitely going to make us all step back and really think about what we're doing and why we're doing it because now we have to tie that to what we're billing for. In some cases, you're not going to be able to just bill the same code every single time. Think of someone with aphasia. You're not necessarily going to be billing language only every time or speech and language every time.

Katie Brown:

You might be changing in between, and that's a reality of aphasia treatment. If they have speech sound production impairment because of their aphasia or they have apraxia or something like that, we have to document that we're actually treating that. And, hopefully, it helps us learn a little bit more, makes us look up new treatments, go outside the box, and and do things do things differently. You know? We're not just writing three sentences of they matched pictures with 80% accuracy giving maximal cues, and they participated.

Katie Brown:

Woo hoo. Because, yeah, I think that when physicians or when people see that, they're like, okay. I'll remember when I was in skilled nursing. When I first started, I was sitting with a patient, and one of the I I want maybe it was a CNA or it was a nurse. They came up to me.

Katie Brown:

They're like, how long did you go to school for this job? She was like she was like, how I want your job. And I was like, okay. I was like, I have a master's degree. And she was like, really?

Katie Brown:

Like, oh, god. Yeah.

Jeanett Benigas:

Yeah.

Katie Brown:

It's like, well, if we're just sitting there watching someone eat during lunch, I don't know.

Jeanett Benigas:

Side note, thankfully, I think a lot of that has come to an end. It does still go on, but if you're still doing it, call me. We'll talk about it.

Katie Brown:

I know.

Jeanett Benigas:

How That's the reason how we were taught, right? We absolutely know better now. We have better

Katie Brown:

that was within my first two years of practicing. And then one of the main reasons I went into private practice was exactly what you said, Jeanette, was I had a client that absolutely needed instrumental swallowing assessment. And I fought like hell for this person. And to the point where the director of rehab was like, I am calling your boss because I was contracted there. I'm calling your boss.

Katie Brown:

I'm calling him right now because everyone else that they've sent to this building has been able to do it without instrument instrumentation, so why can't you? And then the worst part, I then got a call from my boss who said, you're a young clinician. As you get as you get more experience, you won't need the instrumentation.

Jeanett Benigas:

You'll just know. And I said,

Katie Brown:

oh, I can't work for you anymore.

Jeanett Benigas:

Mhmm. I heard that as a as a student in my hospital rotation where someone I was following and working with that day just said to me, you know, you're gonna get a lot better at this as you go.

Katie Brown:

You're gonna get so good at it. Yeah. Your X-ray vision will just develop over time. Don't worry.

Jeanett Benigas:

You know, I have to wonder where mine went, because I used to be so good at it. And now that I hold a scope in my hand, I'm like, girl, you had no X-ray vision, you need to go you need to go to X-ray vision rehab, because you were bad

Katie Brown:

at it. Yeah. So another interesting thing, how many of these companies are aware that our codes are being changed too?

Jeanett Benigas:

Not many.

Katie Brown:

Hopefully, all of them. But is that really what's gonna happen? Probably not. It's going to fall on the SLP to know that this is happening to inform their employer and say, is changing. And then there's some SLPs who still don't even know that this is happening.

Jeanett Benigas:

Oh my gosh. It kills me when I'm

Katie Brown:

on social media. Every time I go on social media, it's like, what about ninety two thousand five hundred seven?

Jeanett Benigas:

When I looked at PhDSLP's first ninety two thousand five hundred seven post about a month and a half ago. I haven't looked at it in a while because I don't look at how posts are doing. But I was just interested because I knew it was getting a lot of attention. It used to be pinned to the top of the content. It's not now, but it's yellow and it came out the beginning to mid ish February.

Jeanett Benigas:

The last time I looked, it had over 300,000 views. There's 200,000 of us, maybe 170, depending on what you look at. Where were these people? And then you really have to worry about all of these people who aren't on social media. Yeah.

Jeanett Benigas:

Which are a lot of older SLPs, to be honest. I I know some younger ones are getting off now, too.

Katie Brown:

Yeah, yeah.

Jeanett Benigas:

I'll tell you that when this process started in February and we were looking at who we were going to add to the team for AMA, we wanted voices from everywhere and I called the company that I've been working for since 2008 because my regional manager lives behind me, our kids are the same age, we hang out all the time and he's like, Yeah, definitely call, we need to get in on this. I called and I tried to express to them like how serious this was, that it didn't have to happen. We had an opportunity to stop this in a very rare occurrence and that having their voice at the table and being a part of it would really help. Also, if we lose, at least they know what's coming and can prepare the company for the changes, they declined. They said, No, we usually get involved in lobbying on the back end of all of that.

Jeanett Benigas:

And I was like, You're dumb. That was dumb. Like now, like after these, okay, so, you know, January 1, now we're going to start to lobby. I mean, you could have done all of that for free, but now you're going to pay $20,000 a month for a lobbyist to try to increase rates? Girl, please.

Jeanett Benigas:

Could have just stayed where we were at, right? And so my guess is there's a lot of people who don't know what's coming.

Katie Brown:

There are a lot of people that don't know what's coming, including SLPs, including employers. Let's get serious. So then that becomes even bigger of a shock. Can you even imagine if people are finding out about this in December or January? And then drastic measures are taken.

Katie Brown:

I I don't know.

Jeanett Benigas:

So let's talk about mixed payer environments, Katie. What challenges do we have there? So we've got these advantage plans, Medicare with UnitedHealthcare secondary. That's kind of where we brought up earlier Medicare with Medicaid secondary. What might that look like?

Jeanett Benigas:

Any idea?

Katie Brown:

Well, I think the biggest question is these new fee schedules that are going to come out. Because although most, I would say most insurance companies look at CMS and they go, Okay, what is CMS doing? And then they base their rates or their conversion factors off of CMS. That's not a 100% guarantee. You know, I have plenty of different payers that pay me different amounts for 92,507 now, and it's only been dropping.

Katie Brown:

So now I fear that these rates are going to drop further now that these insurance companies have the opportunity to say, Well, actually, we're going to value your practice expense at this to potentially give us a pay cut. I'm really thinking that's going to be the case. And the big question is, when is that going to happen? Who knows? I was speaking on the phone to a local insurance company the other day to one of the provider advocates, and I said, all of our codes are being deleted.

Katie Brown:

What's the status on that? Where can I get more information? I'm a proactive person. I'm trying to figure this out so that way, come January, I've smoothed as many wrinkles as I possibly can. She was like, Oh, I I have no idea.

Katie Brown:

I would watch watch our newsletter. Watch you're signed up for our newsletter. Right? I'm sure something will come up about it then. I was like, oh, you're right.

Katie Brown:

I'll just just wait for the newsletter. And who knows? Maybe you'll be ready in January or maybe you won't. And then I won't get reimbursed. You know, my my company won't be reimbursed for who knows how long, maybe Q1.

Katie Brown:

And then again, it falls on these private practices to be able to keep their practice afloat with potential delay in payment while still having to pay themselves and employees. Private practices, we've got thin margins. We don't have huge cash reserves. Anyone who is billing Medicare regularly does not have a huge cash reserve, period. I mean, the Medicare rates are about as low as we go.

Katie Brown:

My private pay rate is certainly above the Medicare rate. Do I have a ton of patients that do private payment? No. It's maybe five to 10% of my practice, maybe. The big question mark is reimbursement.

Katie Brown:

This is the opportunity for insurance companies to decrease our reimbursement as they rehash this. And how delayed are our payments going to be?

Jeanett Benigas:

If you want a really good example, folks, of what this looks like, go ahead back about two years in the fixed SLP content to the New York early intervention crisis, where there were some changes and no one was getting paid. They had not been paid in months. And I'm going through this right now. So my competition, Patheus bought Carolina Speech Pathology probably a little over three years ago. And then they very quickly bought up independent practitioners like myself who had been around for a really long time.

Jeanett Benigas:

I know in Ohio, they bought two practices with great reputations, great clinicians, a ton of contracts, smart business move, and then smart business move for my colleagues to sell. So in those buyouts, they acquired the people, the contracts, and the equipment. And in March, they announced on a Tuesday that they were going out of business, and the next Tuesday, they were closed. Now they acquired a mobile modified barium swallow study van in Ohio that had a contract in probably every nursing home in Ohio. Gone.

Jeanett Benigas:

They now have no contracts anywhere in Ohio. And there are two of us in the state who were up and running. And so we pounced at my business. I've been working a lot, and it's a good thing. I'm not complaining.

Jeanett Benigas:

I'll take it because I've hoped for a long time that I could grow my business slightly to allow me to focus more on PhDSLP because that's how I really get paid and contribute to the family. And it's why actually we can take a vacation right now. This was a very last minute vacation. But in that process, I am negotiating all new contracts. And as of two weeks ago, I was owed $12,000 Not one new contract had paid me.

Jeanett Benigas:

I also said I had to hire someone. I still have to pay her. So I haven't actually been paid until a week ago when I called some of these companies and said, Hey, I'll waive your late fee. If you're interested, if you cut the check today, I'll come pick it up. And so thankfully she's a friend and waited and I didn't have to pay her until I got money.

Jeanett Benigas:

That's not a normal business relationship. But she saw what we were going through, right? Thank God for Kelly. Shout out to Kelly. God bless you,

Katie Brown:

Go, Kelly.

Jeanett Benigas:

But I haven't been paid a dime. And I had to renew my liability insurance. I had to pay for that invoicing system. I mean, I've already upgraded it. I already need more functions.

Jeanett Benigas:

And so now I could see how if there is a delay in payment, oh my God. Like, it's illegal not to pay your W-two employees.

Katie Brown:

In a private practice, the owner takes the hit.

Jeanett Benigas:

Kelly would have insisted on being paid, would have had to take money out of our savings account. But now that I've collected a little bit, okay, now we're going to take that vacation we didn't think we'd be able to take this year, it's a lot. And so I will link up that New York episode in the notes so you can go listen. And I'll even link up last week's in the show notes, too, so you can listen to that. Because if you missed it, yes, it was a lot of pediatric practice talk, but still very, very applicable for the crowd listening today.

Katie Brown:

I think my biggest, just my biggest concerns that I think everyone needs to have an awareness of. Right? I was thinking as we were talking, I'm like, oh, wow. This is so doom and gloom. This is terrible.

Katie Brown:

There can be some good things that come from this. Okay? My stance is not that this is the worst thing in the entire world for medical SLPs. Like everything, it is a mixed bag. I think the things that people need to be aware of are productivity, because I think that there could be some big changes to productivity because of this.

Katie Brown:

They're gonna say, okay. Well, in order to make the same amount, now you just need to see more clients or you need to see them for longer. So we're gonna take some of your documentation time or some of your break time, and we're gonna allocate that to seeing patients. So that way you get we get paid the same amount, and we can keep paying you the same amount. Right?

Katie Brown:

So you're just doing more work. That's one of the big things. The other thing is going to be the reimbursement and the logistics and the administrative changes to that. Like I said, we do forty minute sessions. You know, we had five or six clients that came in more than five minutes late just today on our slowest day.

Katie Brown:

Those are all patients where suddenly we are not able to bill that add on code, and we are taking a loss. So it is about restructuring potential, like scheduling, potentially. I think there is probably also going to be a nudge for upcoding from admin. They're going to say, oh, that's voice. Right?

Katie Brown:

You just did you could bill voice and speech production. Yeah. Bill voice and speech production. Right? And maybe in your gut, you're saying, oh, no.

Katie Brown:

That was really just speech production. But when you have someone who's signing your paycheck going, you can bill for voice, right? I can tell you that a lot of people might crumble under that. And like I said, we had this nice code before that we could treat whatever we wanted for however long we wanted, and we didn't have to worry about all of that. These are things that are going to impact us now, and we need to be aware of them.

Katie Brown:

Because I guarantee they will happen. They're not gonna happen to everyone. I hope that they don't happen a lot, but also being realistic, they are going to happen.

Jeanett Benigas:

I wanna circle back to that upcoding pressure because I think we are at a crossroads. So I'm gonna give a really good example of a place where we've landed that we can't quite get out of that I think people can relate to. With dysphasia treatment, we put the cart before the horse. And we did a lot of treating at bedside without instrumentation. We did a lot of thickening liquid without evidence that it helped.

Jeanett Benigas:

And that's how we always did it for decades. And to our defense, just the evidence wasn't there. And so there are a lot of older SLPs, I would say my age and older and certainly not all of them. This is not please don't become offended. If this is not you, I am not talking about you.

Jeanett Benigas:

But there are a lot of SLPs who will still not ask for instrumentation because they think they can diagnose dysphagia at the bedside. That's like telling an ortho doc to get better at diagnosing a hairline fracture in the office. But we can't get out of this because this is how we always did it. And then when people like me walk in and ask for instrumentation, which just happened to me. I have a corporate contract that is pending that they don't want to sign because of the cost and it's not even that much money and they're giving the SLP a hell of a time because why does she need fees for a trachevent patient who can't even go to the hospital without a whole, like, rigmarole for a modified.

Jeanett Benigas:

Right? I had a great conversation with the director of nursing. Says to me, we've never experienced this before with an SLP. We've never had to do this. Girl, what?

Katie Brown:

What?

Jeanett Benigas:

Bad. So we got ourselves there by saying yes to something we shouldn't have been doing. And now that we're trying to right our wrongs, it's impossible. And so my call to action for medical SLPs is do not say yes to up coding. Because when those of us who are trying to stay ethical and bill ethically and do the right thing for our patients and not take advantage of their insurance, which is gross and disgusting that we're going to take of a sick person's insurance to make our company more money, it doesn't benefit us at all.

Jeanett Benigas:

That we're going to say no to that. When the people who need jobs, the people who don't know better, the young adults coming out of school who are scared, afraid, need the job, don't want to get let go. All say yes when they know that there is someone else in line that will say yes, it will make it impossible for us to stop this. And if we want to get rates up in the future, which I'm going to talk about in our good news segment here in a minute, we need to tell the truth about what we are doing. So as a researcher, I'm a researcher with a PhDsomeone like me knows we need clean, pure, honest results, honest studies and data to get what we want.

Jeanett Benigas:

We have to be able to do studies on what these codes produce if we're going to go fight for more. If we're going to go fight for our profession, we have to tell the truth. We have to say no to that. We can all decide right now. Say no to upcoding for your employer, or we're never going to get anywhere.

Jeanett Benigas:

Crossroads. We already see what's going to happen if we follow the dysphasia instrumentation model, thickening at bedside, not asking for instrumentation. We have a chance to stop it before it starts.

Katie Brown:

I'm in agreement.

Jeanett Benigas:

Pastor John has not come out of me for a very long time, but you just got my sermon today. Okay? You just got it. I'm sorry. I'm I'm not not sorry.

Jeanett Benigas:

I think everything that you just talked about leads into what we would call better utilization data, and that is information that measures how much we use a resource or a service or a time. So in healthcare, how much are codes actually used? And I think when we all look at these numbers, we are going to see reimbursement for standalone language treatment is inexcusably low. Inexcusably Language is in the title of what we do.

Katie Brown:

I am appalled at how low the language is being reimbursed. I am just shocked at how they could value it so low. And as a practice that does mostly cognitive therapy, it's not looking good. So I know that ASHA and CMS and AMA, whoever, the powers that be, have all said, well, you have cognitive codes. You have 97129 and 97130.

Katie Brown:

So this isn't relevant. Right? I I remember being so frustrated in that AMA session of, like, we're not going to add cognitive communication to anything because you don't need it. Yes, we do need it. We absolutely do need it.

Katie Brown:

The cognitive intervention codes, yes, Medicare reimburses them. I only have one other insurance that reimburses them. All the rest, they say SLPs are not eligible to get reimbursed for those services. We've been billing 92,507, and now it's very unlikely they're suddenly going to add those cognitive intervention codes to our fee schedules. So now we're going to have to what?

Katie Brown:

Bill language only? What about if we truly are only working on cognitive function? How do we bill for it? Am I going to just do language only? It's inexcusable to not have a place to put a core treatment for for our patients.

Katie Brown:

Like, met SLPs treat cognition all the time. And I know some people don't like it. I I get it. I see it all over social media. Like, what are we even doing with cognitive therapy?

Katie Brown:

Cognitive therapy is incredibly beneficial when it's done the right way. And we need a home for it. We need to be able to bill 97,129 across the board. And we can't just say, well, this isn't relevant to what we're talking about right now, so we're just not going to talk about it at all. And then it just keeps getting passed on and passed on.

Katie Brown:

And then then it's just left to the clinicians to say, I guess I'm gonna bill language only. Right? We talked about how they can't remember conversations, so I guess that's just gonna have to fit under language only.

Jeanett Benigas:

I am very surprisingly getting really emotional right now, which is shocking to me. Because I have dedicated a career. I know I talk about dysphasia a lot, and I know that I do that because I own a business, right? But people would be shocked to know that that was probably 20% of my doctoral training. I had the amazing privilege of studying with the late way too soon the late Doctor.

Jeanett Benigas:

Michelle Bourgeois, who created memory books in the '80s as part of her dissertation. So if you've ever used a memory book, that is her work and her legacy. And I do understand cognitive therapy. I understand it deeply. And I was one of those people who used to think, What am I even doing?

Jeanett Benigas:

This is shit. This isn't real. People aren't getting better because I'm doing this. And then I went and studied with her and learned about what it really is. And by the way, if you have MedBridge, this is not a pitch to make money because they pay us very little, but she gave me her blessing to teach one of her books in a course.

Jeanett Benigas:

It's a whole dementia series where I invited Jennifer Brush to become a part of that, who's very into Montessori. It's a five course series all about cognitive treatment and specifically dementia, but some of these spaced retrievals, some of these things can be applied to any population. Spaced retrieval has a wealth of data over hundreds of years in different populations, including normal functioning cognition. But I was going to die on the hill at that AMA meeting. I was going to die on the hill that we needed to have cognition somewhere so we could avoid this conversation.

Jeanett Benigas:

Because it is so important as someone who now has a family member on the fast track to dementia. An immediate family member of mine has mild cognitive impairment. And it's just honest to God, I probably wouldn't let the person get speech therapy anyway because I wouldn't approve. But this is so important. And I have been afraid for so long that we are going to lose our profession to occupational and physical therapy.

Jeanett Benigas:

And I think this is another opportunity for that, because they're already replacing us with dysphasia therapy. Left EJS Therapy they were making SLPs train OTs to diagnose and treat dysphasia and then mentor them. I was not going to be a part of that. I left. I know OT was treating dysphagia before SLPs, Okay?

Jeanett Benigas:

But that became part of our scope. We're handing it back to them. Again, there's SLPs saying yes to this. So we're handing them dysphagia. The door's wide open for that.

Jeanett Benigas:

Now, we share a cognitive code with OT. And guess what? Those edits currently don't allow for that code to be billed more than once a day. Yeah. So who's treating it in the SNF?

Jeanett Benigas:

Can pay a CODA to use that code, which is less than what I make. Am I gonna have that opportunity? No. I'm not. Let's be real, folks.

Jeanett Benigas:

I'm not. They're going to pay the CODA in a nursing home to give that treatment.

Katie Brown:

Yeah.

Jeanett Benigas:

So now cognition's gone. Maybe. Mean, this might not happen, but like, this is all like, these are real concerns. So what do we have left? Voice, which isn't treated very often.

Jeanett Benigas:

Yes. Adults need that for sure. But we're not doing a lot of voice in nursing homes. Motor speech Definitely not in nursing homes. Dysarthria, which is kind of I feel like sometimes we let that go to the wayside because we're working on swallowing and cognition and language.

Jeanett Benigas:

But we don't have a lot left. And my fear is that all of our full time jobs are gonna go away. I've even heard of companies having PT treat AAC. Heard a few examples of that. I've heard a few examples of OT doing AAC.

Jeanett Benigas:

We're just letting our profession be ripped from us before our eyes. I've just been watching this over the last five plus years, just watching it happen. And I think this is another opportunity where we're gonna lose something that is core to what we do and is a really deep part of my history. I walked away from being a full time, really good money making SLP back then. Yeah.

Jeanett Benigas:

To go back to school and be poor for years to learn more about this and to contribute to our profession. And I haven't talked about this yet, but I'm gonna go ahead and do a screen share. Take a look. We have the new cognitive procedure coding, What You Need to Know, session ten seventy five presented by ASHA's HCEC, the Healthcare and Economics Committee at the twenty seventeen ASHA Convention. So this was presented on 11/09/2017.

Jeanett Benigas:

So let's remember that year. Take a look at the disclosures. There are two names on here in particular that I would like to point out. The first is Shannon Butkus. Shannon was on the HCEC.

Jeanett Benigas:

Shannon was on the RUC committee that proposed rates to CMS. I think, and I could be wrong, but I fully researched all of the people on the HCEC before I posted about them. And I did say that one of them worked for an insurance company. And at the time, I thought that she was also the co chair with Renee Kinder. So Shannon works for an insurance company.

Jeanett Benigas:

This is confirmed. You can go to her LinkedIn and look at it. Talk about a conflict of interest, number one. Okay? Number one.

Jeanett Benigas:

One thing right there. Okay? Shannon was also potentially the co chair. However, I have questions, and these could just And this could totally be justified. Maybe I'm misunderstanding how this works, but I don't think so.

Jeanett Benigas:

All of these positions are volunteer. Every year, ASHA puts things out for nominations, and they appoint people, and these people work terms. They're overlapping, but they're different, so not everybody is going off these committees and coming on at the same time. Shannon was absolutely on the HCEC when this process started. She absolutely was part of the ruck.

Jeanett Benigas:

The one thing I'm unsure of, because when I look back, including using the way back machine, I can't find this, but I also know I'm not crazy. So she was co chair, I think of the HCEC. And then since February, after all of this got exposed, out of nowhere, one day I go back to the HCEC page and her name is gone and there is now a speech vacancy. What happened to Shannon? Was this a cover your ass?

Jeanett Benigas:

Is that what happened? There's a different co chair now who I don't remember being a co chair again and I have spent hours looking at this stuff. How's there suddenly a new co chair and what happened to Shannon? Again, Shannon, who works for an insurance company, being part of this process. I just so many questions.

Jeanett Benigas:

So anyway, she was part of this. Renee was part of this in November 2017. Neela, who is the ASHA staffer, who represented ASHA at the AMA meeting, and who has been a part of this all the way through, was the ASHA staffer back then. Okay, so we've got Neela, Shannon, Renee, all involved in this now, all involved in this then. Okay.

Jeanett Benigas:

Now let's take a look at this next piece of interestingness. This decision tree, cognitive treatment planning decision tree is when Renee Kinder herself started recommending that SLPs use ninety two thousand five hundred seven to bill for cognition. I just want to be clear, it wasn't to replace ninety seven thousand one hundred twenty nine and '30, which didn't start until 2020. It was going into the 2018 year, which was going to be ninety seven thousand one hundred twenty seven. So you can see that at the top in the blue.

Jeanett Benigas:

But this is when the practice of this started. So it's a yesno decision making tree. I'm going to even try to make it a little bigger here. So does the patient have a new onset of cognitive change? Cognitive skills defined under the treatment codes above.

Jeanett Benigas:

And so there's a yes and no, though no, you're not going to treat. But yes, differential diagnosis. Does the patient suffer from conditions which mirror cognitive change secondary to delirium from any of the following? So polypharmacy, depression, dehydration, like all those things that can get better with medication or anesthesia wearing off. Yes, okay, we're not going to treat.

Jeanett Benigas:

So then no, differential diagnosis. Does the patient have active dementia as defined by the global deterioration scale stage four or greater, so GDS four? Yes. Active dementia includes presence of underlying language impairment. Initiate treatment following comprehension assessment and development of care.

Jeanett Benigas:

If skill need is present, the more appropriate code to use for treatment is CPT92507. Who is getting the bulk of care in the adult population for cognition? Are dementia patients in skilled nursing facilities? When did the overutilization begin? 2017.

Jeanett Benigas:

So people walked away from ASHA convention November 2017 and began using ninety two thousand five hundred seven to treat cognition. So then in 2020, when it changed to our current code set, ninety seven thousand one twenty nine and ninety seven thousand one hundred thirty, we just continued that practice. Now we met with Asha multiple times before that AMA meeting, and I reminded them of this. They denied it, like blatantly denied it. And then I had to pull up the receipts and got a lot of words out.

Jeanett Benigas:

And so I fought for the cognition code even before we got to that table. I fought hard and obviously didn't win. But my point was we need somewhere to put cognition. That, yes, like I know in my head, maybe it doesn't belong under 92,507. Sometimes there's a lot of fraud that happens.

Jeanett Benigas:

But we have to have a way to treat it because twenty nine and thirty aren't usable in many And when they are, the reimbursement is so low, it doesn't even make sense to use it. We can't pay ourselves with the current reimbursement for those codes.

Katie Brown:

And

Jeanett Benigas:

their answer was, We can advocate for higher rates. SLPs are going to have to go back to insurance companies and ask for it to be covered. Okay. So what if we do that? Again, with these NCCI edits, who are they going to let use these codes?

Jeanett Benigas:

I want to circle back to the utilization data, the specificity. What it's going to allow us to do is have stronger advocacy in the future. I've been doing a lot of research about how to get CMS to increase rates. I don't know that our letters are going to do anything right now. What it's going to do is start a paper trail.

Jeanett Benigas:

They're going to want solid data and it's not just you saying this is what I do in my practice. Where we're going to pull this data from are these codes that are billed. Again, why we can't up code. For the next three years, we have to tell the truth with what we're doing and then we can pull that out of the data to take it back to CMS and say, here's what we're doing, here are the outcomes, here's how long it actually takes, here's the work involved, and this is what we need. And through all of this, I think we can gain recognition that speech pathology isn't just one treatment.

Jeanett Benigas:

It's not an in and out home health companies. Are you listening? We need more than three sessions, okay? Yeah. It is not an in and out.

Jeanett Benigas:

We do not have a wand. We need more time. We need more money. We all need to get better to make this happen. If you're sitting there saying, I'm tired of having to fight for what I do, we all should have been doing this in the first place.

Katie Brown:

I know.

Jeanett Benigas:

Okay? I'm guilty of it too. This is how we have been as a practice for decades. It's how we've landed where we're at. And now is the time to right our wrongs and get this thing turned around with or without ASHA.

Jeanett Benigas:

I've got a PhD. I know how to research. I have PhD friends who know how to research. There's plenty of people in academia who secretly message FixSLP because they're scared to lose their jobs. I know people.

Jeanett Benigas:

We can pull data. We can make this happen without ASHA, but we need everybody to tell the truth. We need everybody not to up code and we need you to get better at knowing what you're doing and why you're doing it so you can pull the correct treatment and make a difference for people. So I'm going to end with this question. Could better data eventually help justify reimbursement?

Jeanett Benigas:

Or could it just simply create more administrative work? Which direction do we want to go? Do we want this to be an administrative problem resulting in nothing? Or do we want better reimbursement? Might not happen today, might not happen this year.

Jeanett Benigas:

I pray that we don't lose good SLPs and good practices. I pray we don't lose our profession to OT and PT in the meantime. We're all going to have to fight like hell because med SLPs are in trouble. It's time to wake up. Private practice owners in pediatrics already knew.

Jeanett Benigas:

They saw the writing on the wall. Friends, you need to get involved. It's time. I know we're all busy. But if you want a job in two years from now, you need to get involved.

Jeanett Benigas:

Okay? Yeah. Katie, anything to say before we go? This is almost a two hour episode.

Katie Brown:

You're cutting this down, right? I could probably talk for at least another hour on this. I would say anything that I don't end up covering, I'm going to end up covering when we do our audit and documentation.

Jeanett Benigas:

Right, Katie. So I will see you in maybe like four or five days with a glorious golden tan situation. Maybe I will record with a pina colada in hand. I don't know. We'll see you next week.

Jeanett Benigas:

Thank you for giving your time, your energy, your intelligence to our community. Everybody, join us next week. It's going to be another good one. Thanks for fixing it. Thanks for listening to the FixSLP podcast, the podcast shaking up the field of speech language pathology.

Jeanett Benigas:

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