Private Practice

The link below is a review of medical guidelines/medical necessity completed by ASHA and available for ASHA members.

The purpose of the medical review guidelines for speech-language pathology is to serve as a resource for health plans to use in all facets of claims review and policy development. The guidelines provide an overview of the profession of speech-language pathology including speech-language pathologist qualifications, standard practices, descriptions of services, documentation of services, and treatment efficacy data
 
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Independent Billing Status:
 
Blue Cross Blue Shield of Michigan will allow Independent Practicing Occupation Therapists (IOTs) and Independent Speech-Language Pathologists (ISLPs)  the opportunity to apply to its Traditional and TRUST PPO networks. IOTs and ISLPs may obtain application materials on www.bcbsm.com starting October 1st, 2011.  To ensure special attention of applications, from 10/1/11 to 12/31/11 , please mail applications to:
 
                                     BSBSM - M/C C334
                                     600 E. Lafayette Blvd.
                                     Detroit, MI  48226
 
Blue Cross/Blue Shield Documentation Requirements:
 
MSHA is pleased to relay a recent change in Blue Cross Blue Shield of Michigan's documentation requirements, effective February, 2011.  Per the Blue Cross Blue Shield Record, the requirements for speech-language pathology documentation and certification have been changed to more efficiently provide care to members.  The changes include increasing SLP therapy referral validity from 60 to 120 days; increasing the time-frame for re-certification to 90 days for longer term treatment plans, and elimination the face-to-face physician visit requirement for treatment plan re-certification (written documentation must demonstrate ongoing communication between the referring health care provider and SLP).  Please refer to the BCBS-Michigan Record for specific details. 
 
MSHA representatives met last August with BCBS-Michigan to request a number of changes to documentation requirements to improve efficiency and reduce physician and SLP re-work.  We are very pleased that BCBSM was willing to analyze these requests and to approve them.  Their willingness to work with members of MSHA in the goal of improving service efficiency for patients with communication and swallowing disorders is greatly appreciated. 
 
BCBSM Direct Billing:
 
Blue Cross Blue Shield of Michigan announced yesterday that in September, 2010, it will initiate a project to directly reimburse Speech-Language Pathologists.  Direct billing does not change the requirement that SLPs will need to receive a physician referral to initiate assessment and/or treatment and will continue to follow all requirements for physicians to certify the plan of care.  The project is expected to be implemented in the fourth quarter of 2011.
 
SLPs (and Occupational Therapists)  will be able to bill Blue Cross Blue Shield-Michigan directly, an option that has been available to Physical Therapy for many years. SLPs who provide services to BCBSM clients will follow the usual and typical physician referral and certification requirements.
 
This policy revision, long-sought by MSHA, was one of the objectives of the ASHA Reimbursement Grant MSHA received this year.  Members of the Grant Committee responsible for developing the Reimbursement objectives and strategies include:  Beverly Jaynes, Elaine Ledwon-Robinson, Rick Merson, Julie Pratt, Sherry Riedel and Tim Weise.  We express appreciation to all of you who responded to the ASHA Action Alert requesting letters of support directed to the administration of BCBS-Michigan as well as to our colleagues in Occupational Therapy who provided advice and support.
 
MESSA Billing:
Another success with third party reimbursement has been achieved by MSHA for our consumers and colleagues.  MSHA worked diligently with MESSA to reverse the March, 2010 decision to disallow independent SLPs to bill for speech therapy services.  As of September 1st, MESSA has repealed this decision and will revert to their prior policy which did allow independent SLPs to bill for services.