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Telehealth Coverage Expired: SLP Rules for Medicare Claims: Otter Voice Meeting Notes

Telehealth Coverage Expired: SLP Rules for Medicare Claims

Jeanette Benigas30min

Jeanette Benigas

00:00

Welcome to Fix SLP, the podcast shaking up the field of speech language pathology. We're calling out the barriers that hold clinicians back fixing broken systems that limit our care and giving the power of our profession back to the people who live it every day. This is where fearless clinicians come together. It's time to change the field with our voices, leadership and advocacy leading the way. So let's fix SLP!

Jeanette Benigas

00:32

Hey everybody, welcome to Episode 100, season three! Episode 100. Here we go. We've got a new intro. We've got a new thumbnail on your streamer. We someday are going to have a new website. We don't have it for you today. We've got new branding. We freshened up our colors. We still have Preston, but he's not here today. Today, I've got Katie Brown from neuro speech solutions. Our 100th episode was supposed to be a celebration. It was a look back. I had audio problems, and then every time we tried to come together since me trying to edit, we've had issues. And so we're late this week to a podcast. So we kind of hung out to see what was going to happen with Medicare, and Katie agreed last minute to come on and do this with me. So I've got Katie brown celebrating our 100th episode. Who knew you were gonna have this honor? I know I am truly honored to be the de facto 100th episode podcast guest, I feel like you need a t shirt. We might make that happen.

Katie Brown

01:47

I want it.

Jeanette Benigas

01:50

Speaking of T shirts, I wasn't going to say this, but every fall we do t shirts, and I think this year we were going to kind of open it up to our Fixers to send us some designs, and if we choose your design, we'll give you a free shirt. So send those in team at fix slp.com, send us some ideas. Tell us what you want to see. I have not planned this at all, and I'm going to be really sorry. I might even edit this out, but we'll see. What I am supposed to say is, you know, not a one of us is going to ASHA in Washington DC, but we did decide to go to Washington DC. Nearly all of our team will be there, and we are hosting a party on Friday, November 21 from 7:00 to 9:00 pm. We have rented out a bar, a small, intimate bar, so tickets are limited, but we will be selling tickets. Watch our socials for that, there will be an early bird price. I'm not going to say it, because I have to go over the final stuff, but we'll have some snacks. We'll have our bodies there. Me, Michaela, Elizabeth, for sure, if you all pressure, Preston, maybe him. Alexa, can't make it, but we'll be there to visit with you. We'll have, we have a DJ, but not a dance floor, because we just want it to be intimate, and a place where we can gather, get to know our fixers. Let you get to know us and just have some drinks and snacks in a good time, we might even have some vendors.

Katie Brown

03:26

Sounds great.

Jeanette Benigas

03:29

I booked the place, so we have to start selling tickets. The rest of the details are going to come together pretty quick here. So here we are. Katie, thanks again for coming on, yeah, of course, you and I announced today, this morning, October 1, that as of right now, as of this recording, the Medicare telehealth coverage for traditional Medicare benigasciaries has expired. And it hasn't just expired for us. It's PT, OT, dietitians, a lot of practitioners, are now being held to the previous standard from before COVID 19. Right?

Katie Brown

04:11

Correct, yes.

Jeanette Benigas

04:12

Katie, do you just want to start by telling us why this wasn't extended. What happened?

Katie Brown

04:21

Unfortunately, the government shutdown is the thing that caused telehealth to not be extended. So essentially, we knew that telehealth was extended through September 30, and what needed to happen was Congress needed to come together, come to an agreement and extend telehealth, among many other things, telehealth is unfortunately tied to the budget bill that our congressional leaders could not decide on, and since they did not make a decision on that. That meant that our extension to provide telehealth services for Medicare benigasciaries lapsed. So it's not that we were just denied, it's that they didn't make a decision. So the extension ended. So we have to, we have to move forward with not providing telehealth services right now.

Jeanette Benigas

05:22

Right. And it's not even there just wasn't a vote. I've seen people say that, well, the government shut down. Wouldn't we be under the same rules? That answer is no. There was a hard expiration date. That was September 30. So we woke up today to the government shut down. And that doesn't mean no, they're just extending No, because there was a hard expiration date on there. That was it. Yes. So no, somebody said, Well, I haven't seen anything posted. And, you know, our friends over at ASHA, I've been looking all day (crickets chirping). Nothing. I mean, can we expect anything more out of them? No. So just because they haven't said anything to this point, I'm sure they eventually will, doesn't mean that we can do it. So it doesn't mean we can't provide the service. It just means Medicare, as of right now, won't cover it, and we'll get into some of that. So we posted this morning, and stuff has been coming in all day to the point where I didn't even post our planned Evening Post today, because people were still paying attention to our posts from this morning. And one of the questions I've seen over and over again is, does this affect the schools? What about Medicaid? What about managed care plans? So Katie, we've been trying to answer those questions, but in case people didn't see it, who does this impact right now today?

Katie Brown

06:51

So right now today, this immediately impacts anyone who has traditional Medicare, Part B so services provided by SLPs, as well as as Jeanette said, PTs, OTs, dietitians, a whole slew of other healthcare professionals, we are not going to be able to provide covered Medicare Services telehealth for those individuals. So this does not include individuals who have a Medicare Advantage plan through another commercial insurance. So that is an important distinction. It also does not include Medicaid right now. So Medicare is a federal program. Medicaid are state based programs, so it is only the federal programs that are being impacted right now.

Jeanette Benigas

07:39

I've seen, "Does it affect the schools?" Generally, that answer is no. However, there are some children that receive Medicare that is based on a long term disability. There's all kinds of things that need to happen for children to qualify. So what my advice has been in our social media today is, if you are a provider that bills for a child, just double check their payer source almost every time, the answer is going to be no, but just make sure if you're worried.

Katie Brown

08:12

A lot of people think of Medicare as just elderly, but there are a lot of people under The age of 65 who receive Medicare benefits.

Jeanette Benigas

08:22

What about Part A patients in a nursing home? Do we know? So the reason I'm asking this is because I am currently serving a very underserved skilled nursing facility two hours from my house. They have not had a full time SLP since April, and so I am always the company's last resort, because I make them pay me my PRN rate from the moment my big toe exits the door till the till my big toe goes back in my front door, plus mileage. So they are paying me four hours of drive time, plus the mileage they cannot afford to bring me out more than one day a week, which I totally understand. They're losing money every time I put on my scrubs, and what I told the director of rehab was, let's wait and see what happens. Because I have provided telehealth for a building up in Michigan. I'm down in Ohio, we can do it again. The company will send me a laptop, get me on their remote server. I've done this with them before, we can do it again, but let's wait and see what happens. So this does also include part A. I've looked it up, and so the rollback that we experienced as of this morning mostly applies to part B for Part A and a skilled nursing facility a SNF can technically choose to deliver therapy via telehealth. CMS has said telehealth is not a recognized substitute for required in person care under Part A so like in practice, sniffs could use it as a tool, but it would be at their own risk, and my offer to them was I would still need to come in person, but then let's try this via telehealth, one or two more days a week, because then they could get more services, plus then maybe you could get another PRN to come in, which they've been occasionally able to do. I just said, Let's wait and see. So, for me, from what I've seen online, if I were to provide services to these part a patients, because of the expiration, Medicare still would not officially recognize the encounter as covered under Part A even though it's a bundled payment. So it was already kind of like at your own risk. But now it's, yeah, you you can't do that. It removes the Safe Harbor that was put into place during the pandemic. So no, it's mostly Part B, but you shouldn't be doing it for part A either, unfortunately. So that, and that stinks, because this, you know, this becomes an access to care issue. This is Amish country. I'm driving to Amish country in Ohio, in the middle of nowhere. I don't have a cell phone signal in that building. These people are already struggling for access right and now we had this great solution, because we all know me going there one day a week is helping almost no one. They're not getting but I'm not making them better. I've been getting 25 minutes with some of these Part B people. 25 minutes once a week is not fixing any problems. It's managing crisis after crisis really is what it is. So it was a good solution. Hopefully this, this gets fixed. So we'll talk about that.

Katie Brown

12:04

Yeah. The other big question is, is this permanent or is this temporary? Right? And the answer is, who knows,

Jeanette Benigas

12:13

Right. So what are the options while we wait to see what do? What options do these patients and providers have, because we've put it out there, and I've seen the question that we're going to address now asked a couple of times. So give us the options, and I will pose the question that we've seen all day.

Katie Brown

12:33

Here are the following options that you have. You can cancel all of the telehealth appointments, right? You could potentially say, Let's try for a few weeks. So like, you know, let's try and see see you in a few weeks. If this does end up getting extended, you can see the patient in person. If they are in person, Medicare will pay for the service. The other option is, if the patient truly cannot come in person and wants their therapy, the option is going to be to pay privately for services after issuing an advanced beneficiary notice, which is an ABN, which is a CMS specific document.

Jeanette Benigas

13:17

But Katie, we can't take cash from Medicare recipients. We can't do private pay with people 65 and older. Why could we do it? Now we've seen that question all day. So do you want to explain that?

Katie Brown

13:31

That is the number one question? Yes, everyone has been terrified of accepting private payment from any individual who is a Medicare age. But it's actually not that we can't take cash at all. It's that we can't accept cash for a Medicare covered service. So since Medicare is no longer covering telehealth, that now becomes eligible for cash, private payment,

Jeanette Benigas

13:58

Yep, so you just issue that ABN, we will get that linked up in our show notes if people want to access that. However, if Medicare reinstates the extension and goes retro, or makes it permanent and goes retro, we will then have to issue a refund and submit the claim. So don't take this right now as your opportunity to all of a sudden start taking cash if you don't have an NPI number, if you're not credentialed with Medicare, because you'll have to give them their money back and you won't have a way to submit a claim. So this is a wait and see thing. If this isn't renewed or made permanent, you could be out of time and money. So just wait and see, see where this goes. And then if you want to open your cash telehealth practice, if it's not covered anymore, do that in a month or two. But don't do it tomorrow.

Katie Brown

14:58

No, do not tomorrow.

Jeanette Benigas

15:01

Yeah, so this doesn't apply to people with these managed care plans or other payers. I've seen a lot of people say my employer isn't allowing me to provide any telehealth services. And to me, that's just laziness because they don't want to check the payer source. Yeah, that's an abundance of caution, yeah, and then just blank statements saying we're not going to do telehealth because we don't want to get in trouble, yeah, which is problematic, and I think you could very easily be advocating by looking at their chart to see who their payers are, and then providing the information from Medicare to your employer, because now we're making this access to care issue even worse for people that actually do have the coverage that are being punished because somebody doesn't want to check paperwork. Now, if this is not made permanent, there could be a trickle down effect, right?

Katie Brown

16:02

That's what I anticipate.

Jeanette Benigas

16:04

Yeah, it's starts with Medicare. Everybody follows Medicare. So for sure, the managed care plans would eventually follow suit, and it would be one by one. It's not like all of a sudden no managed care plans would do it. Each managed care plan would make that decision on their own and then notify providers. Medicaid will probably then eventually follow, and then it could eventually be applied to children on Medicaid or private insurers. We don't know. Prior to the pandemic, there were some insurers covering telehealth for children. We don't know the extent of that, because neither of us have worked with children in that capacity, but it was happening because there were people hiring for that job, or maybe they were all just private pay. But that it was happening before, but generally speaking, there would likely be a trickle down effect eventually. So we don't know this is up in the air. Why don't you tell us about some of the repercussions of the shutdown in general. I know that they put out some clarifications today about billing and claims. So why don't you tell us a little bit about that? Because we both had information in our stories that I think could have confused some people. So do you want to explain what all of that said?

Katie Brown

17:29

Sure, so CMS did come out and make a statement addressing the government shutdown, and did, in fact, say the telehealth extension has ended. We cannot process telehealth claims by providers who were temporary telehealth providers by Medicare, so that was confirmed by CMS that we're not able to do that. Another thing that they mentioned was that they are pausing claim processing for services. So as the government is shut down, they're not going to be paying federal workers to process Medicare claims. So right now, they estimate it at being a 1010, business day shutdown for claim processing. In the meantime, you can submit claims if you would like to. However, none of those claims will be processed for their estimating 10 business days could be shorter, could be longer. So again, that's just causing a delay now in reimbursement for individuals who need it, for the providers that need it, as well for the services that they're providing, you know, over these next several weeks.

Jeanette Benigas

18:38

Yeah, so shocker, they're not processing anything but that those are separate things. So the thing one was, yes, they confirmed there was a rollback to pre pandemic services you cannot bill for telehealth. That does not mean submit the claim, and then there's a 10 day hold, and let's see what happens. It means you cannot submit that claim at all. And so then the 10 day hold, and the the lack of processing is going to apply to those in person still covered services. Yeah. So those were two different things that when I read it quickly at a red light in the car, I was like, Oh, can I can my company still submit the claim and then we see what happens in 10 days? No, I read it again later, if for telehealth claims cannot even be submitted.

Katie Brown

19:30

Yes, good distinction. Sometimes these things make once in my head, but need to be spelled out for sure. Yeah, so all care claims are being held. That's not exclusive to the telehealth

Jeanette Benigas

19:43

Now it's a wait and see thing. We don't know you and I have no insider information to when the government is going to open back up. We have no insider information to if they will come to some kind of agreement. We don't know what we do know is Medicare did say, go ahead and give those ABNs if people still want services, just explaining that Medicare won't pay still want service, they'll be responsible for the cost they could it doesn't, I don't even think it says on the ABN, you could be issuing a refund. That's not on there. I wouldn't put it in writing either, but you could tell them verbally, if they vote this through and make it permanent or renew the temporary allowance, then you would get a refund. But there's no promises there, so that's they did say you can do that right in their notification.

Katie Brown

20:41

They said, issue an ABN.

Jeanette Benigas

20:44

Yeah. And then this becomes what we keep saying, this, this is an access to care issue this. This is for the people who have the means to pay for this out of pocket, right? What about the people who don't have the means to pay for this out of pocket? They're just out of luck unless their provider can get to their home for outpatient Part B in person. But a lot of times that's not going to happen.

Katie Brown

21:12

No, unfortunately, I've had to cancel a lot of appointments between today and, you know, tomorrow, Thursday and Friday. So right now, what my clinic has done is we have canceled all telehealth appointments or tried to convert them to in person. But I do see individuals across the state who live hours from me, so they can't reasonably person. We've had to cancel those appointments, we have essentially put them on a hold and let them know we will update you as soon as we get updates.

Jeanette Benigas

21:49

And it's you know, just to really put this into perspective, there are hospice patients who literally can't leave their house, and now they have to have recertifications face to face. I have no words for that. You know, that's not a speech thing. But I mean, this goes, this goes wide. It's not just speech. It goes there is a wide impact here for many people with many medical issues that, yeah, okay, well, "What did we do before the pandemic?" Well, we had systems in place. That was five and a half years ago. Oh my gosh. Can you believe it was five? It was five and a half years ago, right? Oh, my God, I was I was living a different life back then. I'm a different person. How did that go so fast? Anyway, we had different systems in place. Companies were hiring in a different way for different jobs. Whole companies have opened up to provide these kinds of services. Five and a half years, you guys, is more than a half of a decade. I mean, let's put that into perspective. We can't just say, go back to pre pandemic times. More systems have been developed to support people with needs. This is crazy. And you know, we we keep like politics and stuff out of our platform. But, and I wrote it earlier and I took it off because we don't generally make statements like this, but the only people who win here is the government. And that's not left, right, up, down, middle, cross road, whatever. Nobody wins except the people making the budget. That's it, and that's from all sides of party lines. Right? Like this isn't an attack on either side. It's just the only people who win here are the people making the budget, and that is the government. They're saving money, and that's disgusting. A lot of things they do are disgusting, but this, like, tops it for me.

Katie Brown

23:56

Not being able to provide telehealth services in the year 2025, is just not an acceptable response at this point.

Jeanette Benigas

24:06

Right. Right? And I said in that thing that I deleted, I think I kept, that this not only impacts the people we serve, because that's important, but it also impacts our jobs. There are people who have telehealth only jobs, who were out of a job as of this morning when they woke up, not just speech therapists, like I said. There are many people who have been providing telehealth therapy only for some time, and they just don't have jobs today, so it's impacting care, but it's also impacting the economics of our society. So this is this is big. This is a problem. So Katie, we don't know what's going to happen. We don't have answers. What we can say is we're going to keep watching this. And and by we, I mean you. You guys. Katie is not on the fixed SLP team, but she's the perfect example of a clinician who has identified a problem, taking it on herself. Come to us and said, This is what I'm doing. Do you want to collaborate on this? We did our little due diligence, right? We looked her up to make sure she was only half crazy, and then... you can't see her. She did a little smile, you know, once we saw, Okay, she seems legit. Yeah, we'll collaborate, you know, then we, we've been putting out stuff from her. This is going to be our Well, today's post was our third collaboration. This is the second time on the podcast, right? No, yes, I've been on your podcast. Yeah. Okay, I didn't know if it was two times. This is Yeah, yeah, second time in a month. You're hired with all the monopoly dollars that I pay the rest of the team. The Do you want the pink or the blue? It's up to you.

Katie Brown

26:01

I'll take the blue.

Jeanette Benigas

26:02

Perfect. It's in the mail. So she's just the that perfect example of she saw a problem that needed fixed. She has taken it on, and she is letting us know, like, Hey, this is happening. Do we want to post? And so we'll do that with you. She's not the only one. We'll do that with whoever, because we can't do it all. We can't do everything. It's going to take all of us doing our part to fix the things that need to be addressed in this field. So Katie is going to keep watching. I will keep a general eye on it, because my folks in Amish country need service. They do and I have the time to service them from my basement. I just don't have four hours a day to get out there. And the company, they don't have the money, we'll keep watching, keep watching our content. What can people do in the meantime? Katie, how do we take action if people want to do something. What can they do?

Katie Brown

27:02

First recommendation is going to be to call your representatives. Call your representatives if you haven't downloaded my telehealth advocacy Toolkit, which I know Jeanette has posted on the fix SLP website. It's also on my website as well. You can download that. It'll tell you exactly how you can find your congress representatives. Give them a call, let them know that this shutdown has very far reaching effects and that our patients need access to care.

Jeanette Benigas

27:33

Yeah, it is linked up at the top of fixslp.com, we will also put it in the show notes. I will also link Katie's last podcast in the show notes, so you can give that a listen if you're interested. And we'll just keep adding resources. If there's things that you can do, we'll just link it all there. But as of right now, it's just a wait and see. Let your patients know, provide the service if they're willing to pay, call your reps, and fingers crossed that this gets worked out and gets worked out quickly, but be prepared, because they might keep dragging their feet. Anything else on this topic, we're good. There's one more thing I want to do before we go. We did the on our way to 100k downloads contest starting, I don't know, three months ago, we hit it before our 100th episode. We hit it before our two year anniversary, and we had contests all the way through, plus a bingo card that people could do that was in line with all of the contests, plus some extra stuff. We pulled a name. I haven't announced it yet, so nobody has been notified, but I want to congratulate Sarah, who has won one year of continuing education from speech therapy. PD, they donated that to us. She's got a one year subscription so she can do 100 hours. She could do one hour, she can do whatever she wants with it. Sarah, you if you're listening, you don't have to contact us. I know who you are from your bingo card entry, and I will get in contact with you. So congratulations to Sarah. Thank you everyone who supported us over the summer through our summer school series, and who took part in sharing their episodes or rating and reviewing us. You guys are awesome. So here's to year three. Here's to season three! Here's to Katie. She's the winner. She got to be the the guest. So Katie, thanks for coming on last minute. We really appreciate you. And you guys, we'll just keep you posted. So if that's it, I'll say, Thanks for fixing it. We'll see you next week!

Jeanette Benigas

29:49

Thanks for listening to the fix SLP Podcast, the podcast shaking up the field of speech language pathology. Don't forget to check out our social media or fixslp.com for our latest promo codes for continuing education, therapy materials, merch and more. Supporting our sponsors also supports our Fix SLP team. Don't just listen, be a part of the change. Share this episode and our social media content, and let's keep fixing the field one fight at a time!

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