ASHA’s Payer Summit: Conversations with Insurance Companies and State Medicaid Agencies to Help You Get Paid for Your Services

On October 4-5, 2023, ASHA held its annual Payer Summit, which generated robust discussions of the many ways audiologists and speech-language pathologists (SLPs) deliver health care across settings and through many payers. Attendees included representatives from private insurance and utilization management companies, state Medicaid agencies, and Medicaid managed care organizations (MCOs) who discussed coverage, coding, and payment policy issues for audiology and speech-language pathology services. This year’s Summit was held at ASHA’s Washington, DC, office and was the largest Summit yet, with 24 representatives including medical directors, therapy staff reviewers, state education agency staff, and others.

Benefiting ASHA Members by Building Bridges and Providing Education

The Summit kicked off with ASHA providing background to educate payers about ASHA, who our members are, and what their main concerns are when working with payers. Topics included ASHA member pain points―such as payment reductions, coding and billing, prior authorization requirements, responding to denials and audits, lack of coverage for certain services, and Medicaid billing in schools.

The Summit not only focused on identifying challenges for ASHA members, but also challenges for payers in administration of their speech, language, and hearing benefits. Payers noted challenges with member documentation, prior authorization and utilization management, and the need for maintaining frequent/regular communication with the payer throughout the approval and submission.

Attendees worked through strategies with ASHA staff to address key issues impacting audiologists and SLPs. Some positive outcomes included identifying ways in which clinicians can more successfully engage with payers directly, and how ASHA and payers can continue to strengthen our working relationships and proactively address issues together.

A variety of ASHA resources were shared with the payers, showcasing the work that ASHA does in the policy arena such as submitting public comments, responding to payer policy changes, and updating our tools and resources to support members. We gathered real time data throughout the presentations via polling software to help pinpoint areas where payers and members alike would benefit from education. Payers often use ASHA resources to develop their own policies, so these updates are key to ensuring the most current research and best practices underscore the payer policies with which audiologists and SLPs must comply.

What’s Next

ASHA is developing resources for both our members and payers surrounding commonly cited issues, including the specialized role of the audiologist and SLP in treating specific conditions for payers to understand; flowcharts for educating ASHA members on the intricacies of how a claim is processed and what information they can convey to patients to ensure prompt processing and payment; and critical elements of documentation for every claim submitted.

Background

The payer summit was created in 2019 to forge relationships between health insurance payers and ASHA members and staff. While this year was the largest summit yet, it builds on critical relationships that ASHA has been forging for years while developing new relationships with Medicaid agencies that have not been a focus in the past. These relationships help ASHA staff serve our members by establishing key contacts for coverage questions with each payer; thereby, resolving member issues faster and creating swift communication pathways that would otherwise not exist.

Questions?

For questions, please contact ASHA’s health care and education policy team at reimbursement@asha.org.