Medicare Law Is in for Repair Under New Provision, SLPs Could Bill Directly Policy Analysis
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Policy Analysis  |   May 01, 2002
Medicare Law Is in for Repair
Author Notes
  • Reed Franklin, is the director of ASHA’s Capitol Hill office.
    Reed Franklin, is the director of ASHA’s Capitol Hill office.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   May 01, 2002
Medicare Law Is in for Repair
The ASHA Leader, May 2002, Vol. 7, 1-8. doi:10.1044/leader.PA.07092002.1
The ASHA Leader, May 2002, Vol. 7, 1-8. doi:10.1044/leader.PA.07092002.1
A new bill in Congress would correct a longstanding flaw in Medicare—and finally allow direct billing by speech-language pathologists.
ASHA has worked with Congress to craft legislative language to give SLPs the same billing status as physical therapists (PTs) and occupational therapists (OTs), who can get a Medicare number and bill directly for their services. SLPs can be paid if they work for an entity that has a provider number—such as a hospital, nursing home, or clinic—but cannot bill directly as independent practitioners.
S. 1395, introduced by Sen. John Ensign (R-NV), and a companion bill will be introduced by Rep. Fred Upton (R-MI) that would allow direct billing by SLPs for outpatient services to Medicare beneficiaries.
Medicare’s current restriction has dealt a blow to patients, as well as to SLPs in private practice who cannot get reimbursed for the same services offered by their peers in other settings.
Dana Deimel, a Michigan SLP in private practice, says, “We only opened a year ago, but already have had to turn away potential clients who have Medicare.”
Pat Durland, an SLP and billing representative at the University of Nevada, Reno, has experienced the same problem. “We have to either absorb the costs of evaluating and treating patients or bill them for services,” she says. “Some patients decline needed services because their income is too low to pay for these procedures.
“Patients are adversely affected by the lack of Medicare reimbursement to private practice SLPs,” she adds. “They are forced either to go to more expensive and impersonal facilities or pay out of pocket.”
If the bill became law, it would most benefit SLPs in private practice, but also would have a positive ripple effect on the profession. Clinicians are sometimes reluctant to open a private practice, knowing that they cannot get reimbursed for services to Medicare beneficiaries.
A Medicare change would affect private insurers, who often follow Medicare’s lead on reimbursement, making it more likely that private practice SLPs could bill insurers directly in the future.
“For me, it’s a matter of professional pride,” says Nancy Creaghead, ASHA president. “For Medicare to say that the speech-language pathology profession does not have the same status as PTs and OTs is not acceptable.” A resident of Cincinnati, Creaghead plans to write her senators and representative in Congress in support of the bill.
Passage won’t be easy, however, because the bill doesn’t have the broad impact on voters that patients’ rights legislation or a Medicare drug benefit would have. “Since this is not a highly visible issue, we need a strong grassroots letter-writing and personal contact response,” says Monica Ferguson, chair of ASHA’s Governmental Relations and Public Policy Board. “The only way we’re going to get this passed is by combining our work on Capitol Hill with letters and visits from members.”
What You Can Do
Don’t wait—contact your representative and senators now and urge them to cosponsor S. 1395 and the upcoming companion House bill. For contact information, talking points, and sample letters, visit ASHA’s Political Action Center site. Don’t forget to insert personal stories, especially as they relate to the elected official’s district or state. For more background information on this issue, see the issue brief on independent provider status at ASHA’s Web site.
Personal contact is even more effective than letters. Members of Congress welcome visits from constituents at their Capitol Hill and home district offices. You can tell them in person how this issue has affected SLPs, your practice, and your patients. To plan an effective visit, see the “how to” package on ASHA’s Web site.
This year, 2002, midterm elections will be held, and voting is essential. ASHA has developed a “Get Out the Vote Campaign,” which can be accessed at ASHA’s Web site.
Another important tool for bringing about legislative victories is the ASHA Political Action Committee, ASHA-PAC. Contributions to ASHA-PAC are used to support candidates for office who support professional issues that benefit SLPs and audiologists. ASHA-PAC was an essential tool in passing the Medicare cap moratorium and will be vital to the efforts to repeal the cap altogether. ASHA members can learn more about ASHA-PAC online.
For more information about independent provider status for SLPs under Medicare, ASHA’s legislative efforts, or ASHA-PAC, contact Reed Franklin through the Action Center at 800-498-2071, ext. 4473, or by email at rfranklin@asha.org.
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FROM THIS ISSUE
May 2002
Volume 7, Issue 9