July 1, 2013 Columns

In Private Practice: Should You Become a Medicare Provider?

Is it a good business move? Here are some factors—and the process—to consider.

Is there anything more gratifying than helping someone accomplish what that person most wants in life? I don't think so. Speech-language pathologists often find immeasurable reward in the look of pleasure on the face of an older adult who is suddenly able to communicate again after having lost that ability or in the satisfaction of helping someone to once again savor a favorite food.

130701_in-private-practice

As a Medicare provider, you can realize this reward—and introduce a whole new client base to your practice, thereby dramatically increasing your bottom line. So, what are you waiting for?

Here are some questions for you to ponder—and some answers to consider.

  • Why did you become a communication disorders professional?
  • Why should you consider becoming a Medicare provider?
  • Is it an economically viable decision?
  • What does it take to open this new avenue of patient care?

You likely chose this field to help people and/or because you found it interesting. You also want to make a decent living.

Does becoming a Medicare provider fit into that picture? I firmly believe it does, even with documentation rules and requirements that require providers to report outcome data with a new set of codes. If you do the paperwork correctly, Medicare will pay you as promptly as any other third-party payer. And if you so choose, Medicare will deposit payments directly into your bank account.

Most important, because SLPs do not have an "opt-out" provision, if you see Medicare-eligible patients, you must be a Medicare provider. Accepting Medicare adds a significant number of potential clients with a stable payment source.

Medicare does not have one standard rate for every location or every type of provider. There are several factors to consider when calculating your rate, which are listed on the ASHA website. If you want to know the exact rate for your geographic location, follow the instructions below. Or, for a general idea of what Medicare pays for speech-language services, take a look at the Medicare Physician Fee Schedule on the ASHA website.

Enrolling as a Medicare provider involves several steps. ASHA offers explicit and detailed information that takes you step-by-step through the process. In general, you need to:

  • Obtain a National Provider Identifier, a unique identification number for covered health care providers that is required for Medicare enrollment.
  • Enroll through the online PECOS (Provider Enrollment, Chain and Ownership System) site. Using the online process minimizes entry and review errors, which will expedite the process.
  • Get familiar with the enrollment process. Go to the website of your local Medicare contractor—the entity that will process your Medicare payment claims—and see what resources it offers. Learn the basic enrollment steps and make sure you are using the correct enrollment form—the form is different for individual and group practices.

You may have heard that there is a lot of extra work to bill Medicare, but I believe that statement really is not true. Yes, you need to have the patient's doctor sign a treatment plan every 90 days and you must put the G-codes (outcomes measurement codes) on your billing forms. The rules for documentation and billing are available at on.asha.org/medicare-coverage or in chapter 15 of the Medicare Benefit Policy Manual.

Many Medicare requirements are eventually adopted by Medicaid and private insurance plans. Given the growing pressure to demonstrate accountability, outcomes will likely be required by Medicaid and private third-party payers in the near future. The method used by Medicare, functional reporting using G-codes, is required for all Medicare beneficiaries receiving therapy services. This reporting requirement simply involves adding two additional lines to your billing form to show the patient's current level of function and projected level at discharge.

For complete G-code instructions, go to our reporting page.

Fortunately for members, ASHA has the National Outcomes Measurement System—developed in the late '90s and recently upgraded and improved—that helps clinicians track patient progress and outcomes. SLPs can use NOMS to track their patients' progress, to readily convert the NOMS data into appropriate G-codes, and to compare their patients' outcomes with aggregated national data from patients with similar characteristics and diagnoses (see ASHA Launches New, Improved NOMS to Aid Functional Outcomes Reporting).

In its ability to track data related to measurable outcomes, ASHA is ahead of other therapy disciplines, which are just beginning to develop systems that quantify their patients' improvements.

By this point, I hope you are convinced about becoming a Medicare provider. What are you waiting for? Think of all the help you can provide to eager older adults and what an interesting new market is available for your practice.

Barbara Samuels, MA, CCC-SLP, has been in private practice since 1974 and became a Medicare provider in 2010. She also ran a rehabilitation agency for 14 years. She is a past president of the American Academy of Private Practice in Speech Pathology and Audiology and has written a Medicare manual for private practice. basccd@yahoo.com

cite as: Samuels, B. (2013, July 01). In Private Practice: Should You Become a Medicare Provider?. The ASHA Leader.

Find Your Local Fee Schedule

  1. Go to http://www.cms.gov/apps/physician-fee-schedule/overview.aspx.
  2. Click Start Search.
  3. Click Accept.
  4. To see payment rates in your area:
    • Select the year.
    • Select "Pricing Information."
    • Choose to look up a single billing code or range of codes.
    • Select "Specific Locality."
    • Enter the code(s) you are looking for.
    • Under "Modifier" select "All Modifiers."
    • Select your locality (they are not in alphabetical order).
    • Results will include four rates, based on facility and the type of enrollment.


  

Advertise With UsAdvertisement