TSHA Business Management Committee

The purpose of the TSHA Business Management Committee is to provide guidance and support to members/clinicians in a variety of practice settings regarding issues of reimbursement, documentation, insurance changes, and challenges for coverage (Medicare, managed care organizations [MCOs], private insurance, etc.).

Our goal is to offer reimbursement and business-related resources and education to speech-language pathologists (SLPs) and audiologists across the state of Texas. Such efforts initially will be pursued through education courses at our state convention and will be further pursued through the TSHA website and other networking opportunities throughout the state.

Members of the TSHA Business Management Committee compiled the following resources that TSHA members may find useful in adapting practice approaches to address current reimbursement challenges (September 2018).

Resources (General)

SLP Settings for Children and Adults with Communication Disorders

Resources for Practice Management

Business Entity Structures for SLPs in Private Practice
How to Buy or Sell a Private Practice
Minimizing Risk & Exposure
Negotiating Insurance Contracts
Nuts & Bolts of Contracting in the Allied Health Industry

Resources for Reimbursement

2018 ICD-10-CM Diagnosis Codes is a helpful resource to reference for accurate ICD-10 coding, including common codes for SLPs/audiologists. This booklet is a concise version compared to the 1200+ page ICD-10 coding book that includes all ICD-10 medical codes.

Novitas Solution Local Coverage Determinations (LCDs): Novitas Solutions is the Medicare Administrative Contractor (MAC) assigned to Texas and 10 other states. This guide gives their allowances and requirements for Medicare billing, including their list of accepted CPT and ICD-10 covered codes.

Specialized Telecommunications Assistance Program (STAP) forms 3906 and 3907 are required by the Texas Health and Human Services Commission (HHSC) to apply for augmentative and alternative communication (AAC) device funding. 

The Definition of Speech Therapy Encounter as updated September 2017 by the Texas Health and Human Services Commission (HHSC).

The Texas Medicaid Provider Procedures Manual and Provider Types and Places of Service Changes are resources for finding answers to Medicaid provider questions for reimbursable services and places of service.  

Tips for Completing SOAP Notes for Medicare Advantage Risk Adjustment is a good resource to utilize for completing acceptable documentation in the medical/clinic setting to be accepted by Medicare and Medicaid.  

CarePoint SOAP NOTE Abbreviations is a good resource for finding abbreviations to be used in therapy notes that are accepted by insurance and medicare providers. 

An ASHA Leader article regarding Medicare’s New Payment Model in which the author describes the new Medicare quality reporting system likely to affect audiologists and SLPs in 2019.

Assuring the Complexity of Medicare Requirements and Reimbursement (Milliken 2018)
Assuring Accuracy with Medicare Coding (Milliken & Lancaster 2018)
Assuring Documentation to Support Medicare/Medicaid Requirements and Reimbursement (Milliken 2018)

Resources for Audiologists regarding the use of MIPS with Medicare patients

THE MEDICARE ACCESS AND CHIP AUTHORIZATION ACT OF 2015: The Merit-Based Incentive Payment System (MIPS) defines the Medicare Quality Payment Program, describes the goals of the Secretary of Health and Human Services, and provides a general explanation of MIPS.

Important Changes to Quality Reporting for 2017, published on the American Academy of Audiology (AAA) website, provides helpful background information about the transition from PQRS to MIPS and what this means for audiologists who are working with Medicare patients.

2018 Quality Payment Program Final Rule from the AAA website.

2017 Medicare Fee Schedule for Audiologists from the American Speech-Language-Hearing Association (ASHA) website.

Resources for Pediatric Audiology

National Correct Coding Initiative (CCI) Edits for Audiology Procedures details the CCI edits related to audiology and has been prepared based on the complete list of edits published on the CMS CCI website.

The Texas Medicaid Provider Procedures Manual provides answers to Medicaid provider questions for reimbursable services and places of service. 

Audiology Continuing Education Online Classes from Audiology Online includes 1400+ online courses developed by leading audiologists and industry experts.

Information provided by TSHA does not supersede the clinical, legal or financial judgement of the practitioner, nor does it dictate a payer’s reimbursement policy. In all cases, practitioners remain responsible for their clinical practice and the use of correct coding procedures.