ASHA Resource Justifies Medical Necessity for Speech-Language, Hearing Services A new ASHA resource may help audiologists and speech-language pathologists clarify to insurers that speech, language and hearing services meet medical necessity criteria. Insurers reimburse for speech, language and hearing services only if those services are “medically necessary,” and the definition of medical necessity can vary from payer to payer. ... ASHA News
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ASHA News  |   December 01, 2017
ASHA Resource Justifies Medical Necessity for Speech-Language, Hearing Services
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Hearing & Speech Perception / ASHA News & Member Stories / ASHA News
ASHA News   |   December 01, 2017
ASHA Resource Justifies Medical Necessity for Speech-Language, Hearing Services
The ASHA Leader, December 2017, Vol. 22, 62. doi:10.1044/leader.AN5.22122017.62
The ASHA Leader, December 2017, Vol. 22, 62. doi:10.1044/leader.AN5.22122017.62
A new ASHA resource may help audiologists and speech-language pathologists clarify to insurers that speech, language and hearing services meet medical necessity criteria.
Insurers reimburse for speech, language and hearing services only if those services are “medically necessary,” and the definition of medical necessity can vary from payer to payer. Even though there is not one standard or generally accepted definition, the medical necessity webpage can help support arguments that speech-language and hearing services meet the criteria.
Determining medical necessity takes into consideration whether a service is essential and appropriate to the diagnosis and/or treatment of an illness, injury or disease. The U.S. National Library of Medicine defines “disease” as “an impairment of the normal state.” Loss of hearing, impaired speech and language, and swallowing difficulties all reflect an impairment of the normal state, and services to treat these impairments must be regarded as meeting medical necessity.
Health plans that are compliant with the Affordable Care Act must also cover habilitation services, which are included in the federal definition of medically necessary: “Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms, including habilitation, and that meet accepted standards of medicine.”
ASHA’s medical necessity webpage includes information on the definition of medical necessity, why audiology and speech-language pathology services meet the definition, documentation necessary to establish medical necessity, and what to do if a claim is denied.
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December 2017
Volume 22, Issue 12