1
00:00:12,384 --> 00:00:14,544
Welcome to the Swallow Your Pride podcast. I'm

2
00:00:14,544 --> 00:00:16,864
your host, Teresa Richard. I'm a board certified

3
00:00:16,864 --> 00:00:18,964
specialist in swallowing and swallowing disorders,

4
00:00:19,345 --> 00:00:21,585
a mobile thieves business owner, and founder of

5
00:00:21,585 --> 00:00:22,964
the MedSLP Collective.

6
00:00:23,345 --> 00:00:25,505
This podcast is all about delivering the latest

7
00:00:25,505 --> 00:00:27,204
evidence based practice to medical

8
00:00:27,519 --> 00:00:28,260
SLPs everywhere.

9
00:00:28,560 --> 00:00:31,039
Whether you're a new clinician seeking tangible tools

10
00:00:31,039 --> 00:00:33,119
for treatment or a seasoned vet stuck in

11
00:00:33,119 --> 00:00:35,039
a rut, my goal is to help ditch

12
00:00:35,039 --> 00:00:36,640
the old school ways of the past that

13
00:00:36,640 --> 00:00:38,799
no longer serve you or your patients, to

14
00:00:38,799 --> 00:00:41,204
reinvigorate your passion for our field, to broaden

15
00:00:41,204 --> 00:00:43,364
your knowledge about our scope of practice, and

16
00:00:43,364 --> 00:00:45,125
to inspire you to practice at the top

17
00:00:45,125 --> 00:00:47,204
of your license. So if you're listening, I

18
00:00:47,204 --> 00:00:49,524
encourage you to swallow your pride, be open

19
00:00:49,524 --> 00:00:51,684
and willing to learn because let's face it,

20
00:00:51,684 --> 00:00:54,244
your patients deserve that kind of care. With

21
00:00:54,244 --> 00:00:56,104
that, let's dive right in.

22
00:00:56,649 --> 00:00:58,810
Just a quick disclaimer that all statements and

23
00:00:58,810 --> 00:01:01,289
opinions expressed in this episode do not reflect

24
00:01:01,289 --> 00:01:04,090
on the organizations associated with the speakers and

25
00:01:04,090 --> 00:01:05,709
are their own opinions solely.

26
00:01:06,170 --> 00:01:07,549
Good morning, Lisa Johnson.

27
00:01:08,170 --> 00:01:10,569
Good morning. How are you? Good. How are

28
00:01:10,569 --> 00:01:12,405
you? Thank you so much for joining me.

29
00:01:12,805 --> 00:01:13,864
Yes. Yes.

30
00:01:14,244 --> 00:01:16,724
Always always a pleasure. Yes. You were like,

31
00:01:16,724 --> 00:01:18,084
what was that old game show where it

32
00:01:18,084 --> 00:01:19,625
was like you could phone a friend?

33
00:01:21,045 --> 00:01:22,884
What was that? Remember? I can't remember. You

34
00:01:22,884 --> 00:01:25,204
had options. And one was like be a

35
00:01:25,204 --> 00:01:27,125
millionaire. Yeah. Was it? Yeah. Yeah. Yeah. Yeah.

36
00:01:27,204 --> 00:01:29,099
Before that though? Yeah. I don't know. I

37
00:01:29,099 --> 00:01:31,659
don't remember. But, anyways, I am using my

38
00:01:31,659 --> 00:01:33,739
option to phone a friend and phoning my

39
00:01:33,739 --> 00:01:36,379
friend, Lisa Johnson, because she knows all things

40
00:01:36,379 --> 00:01:39,019
about coding and billing. And, you know, obviously,

41
00:01:39,019 --> 00:01:41,579
if anybody's been following me online these days,

42
00:01:41,579 --> 00:01:45,064
I've been very passionate and very outspoken about

43
00:01:45,064 --> 00:01:46,765
these nine two five zero seven changes

44
00:01:47,144 --> 00:01:49,704
because I truly, to my core, believe that

45
00:01:49,704 --> 00:01:52,185
these are good and overdue changes, and we

46
00:01:52,185 --> 00:01:54,265
will talk about why I feel that way.

47
00:01:54,265 --> 00:01:56,189
And if you disagree with me, that's fine.

48
00:01:56,189 --> 00:01:58,750
You are totally entitled to your opinion and

49
00:01:58,750 --> 00:02:00,590
what you feel might be valid because there

50
00:02:00,590 --> 00:02:01,329
is a lot

51
00:02:02,030 --> 00:02:04,349
of terrifying unknown out there. You know? And

52
00:02:04,349 --> 00:02:06,109
I think Lisa just had a great point.

53
00:02:06,109 --> 00:02:08,314
We were talking off air. You know? There's

54
00:02:08,314 --> 00:02:10,395
no reason to panic when we just don't

55
00:02:10,395 --> 00:02:11,835
know what the outcome is gonna be when

56
00:02:11,835 --> 00:02:13,294
we can actually be proactive

57
00:02:13,995 --> 00:02:15,194
and be part of the change. And I

58
00:02:15,194 --> 00:02:16,635
think that's one of the things that I'm

59
00:02:16,635 --> 00:02:18,335
most excited about is that

60
00:02:18,635 --> 00:02:20,830
this is the opportunity we've been asking for.

61
00:02:20,830 --> 00:02:22,909
We've been asking to be heard. We've been

62
00:02:22,909 --> 00:02:25,469
asking to have more codes. We've been asking

63
00:02:25,469 --> 00:02:27,889
to be recognized in a more complex way,

64
00:02:28,030 --> 00:02:29,949
and now it's here, and we're not happy

65
00:02:29,949 --> 00:02:31,889
with what's being proposed. But

66
00:02:32,270 --> 00:02:34,004
the best part about this is this is

67
00:02:34,004 --> 00:02:36,084
a proposal. This is a starting point. There's

68
00:02:36,084 --> 00:02:38,564
lots of open comment periods for us to

69
00:02:38,564 --> 00:02:40,245
express how we feel and to give our

70
00:02:40,245 --> 00:02:42,745
clinical opinions. And I think one thing

71
00:02:43,044 --> 00:02:45,284
that's been abundantly clear to me over these

72
00:02:45,284 --> 00:02:46,950
last few weeks that I've been really outspoken

73
00:02:46,950 --> 00:02:48,870
about this is I only can speak from

74
00:02:48,870 --> 00:02:50,490
my own lived experience. Right?

75
00:02:51,030 --> 00:02:53,030
And people will type into me, like, that's

76
00:02:53,030 --> 00:02:54,870
not my experience with this code and this

77
00:02:54,870 --> 00:02:55,689
patient population.

78
00:02:56,069 --> 00:02:58,310
And I I can only speak from my

79
00:02:58,310 --> 00:02:59,129
lived experience.

80
00:02:59,574 --> 00:03:01,974
And that's why I want to encourage everyone

81
00:03:01,974 --> 00:03:03,734
to speak up because we all know what

82
00:03:03,734 --> 00:03:05,354
we do is so complex.

83
00:03:05,894 --> 00:03:08,215
We work from birth to death. Right? We

84
00:03:08,215 --> 00:03:10,715
work across a myriad of different conditions.

85
00:03:11,094 --> 00:03:12,775
We have kids that are verbal. We have

86
00:03:12,775 --> 00:03:16,099
adults that are nonverbal. We it everything impacts

87
00:03:16,319 --> 00:03:17,780
everyone so differently.

88
00:03:18,479 --> 00:03:20,319
And I I can't say this enough. I

89
00:03:20,319 --> 00:03:22,080
can only speak from my own lived experience,

90
00:03:22,080 --> 00:03:24,020
and I never ever mean to

91
00:03:24,639 --> 00:03:27,280
say this applies to everyone because that's never

92
00:03:27,280 --> 00:03:29,884
the case. But my whole point in speaking

93
00:03:29,884 --> 00:03:31,405
out about this is to get people to

94
00:03:31,405 --> 00:03:33,324
look into it, to dig into it because

95
00:03:33,324 --> 00:03:35,324
I think there's so much information out there

96
00:03:35,324 --> 00:03:37,645
that we as speech pathologist just don't know

97
00:03:37,645 --> 00:03:39,884
to begin with, and then and that can

98
00:03:39,884 --> 00:03:41,645
be paralyzing. And then how do we actually

99
00:03:41,645 --> 00:03:43,669
advocate for change? So I've gotten on a

100
00:03:43,669 --> 00:03:46,389
roll. Lisa, introduce yourself to the people. No.

101
00:03:46,389 --> 00:03:47,129
And I think,

102
00:03:47,590 --> 00:03:49,909
I think it's very interesting, especially when we're

103
00:03:49,909 --> 00:03:51,610
looking at coding and

104
00:03:52,389 --> 00:03:52,889
really,

105
00:03:53,750 --> 00:03:55,669
you know, we've had a few codes introduced

106
00:03:55,669 --> 00:03:57,824
in the past few years. So, like, caregiver

107
00:03:57,824 --> 00:04:00,145
training code, which was an amazing advocacy win

108
00:04:00,145 --> 00:04:02,544
for us. We've been wanting something like this,

109
00:04:02,544 --> 00:04:03,044
and

110
00:04:03,905 --> 00:04:06,965
whenever you talk about whether it's coding revision,

111
00:04:07,025 --> 00:04:09,925
addition of new codes, or deletion of codes,

112
00:04:10,385 --> 00:04:11,925
you're opening up a can of worms.

113
00:04:12,439 --> 00:04:15,719
And we've been, you know, fortunately or unfortunately,

114
00:04:15,719 --> 00:04:17,560
however you wanna look at it, we've been

115
00:04:17,560 --> 00:04:20,060
in this really sweet spot as speech pathologists

116
00:04:20,199 --> 00:04:21,740
for fifteen years

117
00:04:22,040 --> 00:04:24,439
where we've had this big catch all code,

118
00:04:24,439 --> 00:04:25,819
92507,

119
00:04:26,224 --> 00:04:27,985
and we've been able to kinda dump almost

120
00:04:27,985 --> 00:04:29,365
everything into it

121
00:04:29,824 --> 00:04:32,485
at almost our own peril. And,

122
00:04:33,185 --> 00:04:35,104
you know, a lot of us haven't even

123
00:04:35,104 --> 00:04:36,305
been practicing that long.

124
00:04:36,944 --> 00:04:38,704
You know, fifteen years ago, a little over

125
00:04:38,704 --> 00:04:40,884
that was when I started practicing, and

126
00:04:41,300 --> 00:04:42,579
we just had this code. It was like,

127
00:04:42,579 --> 00:04:44,259
yeah. We have this amazing code we get

128
00:04:44,259 --> 00:04:45,560
to dump everything into.

129
00:04:45,939 --> 00:04:47,800
And I think a lot of us

130
00:04:48,180 --> 00:04:50,199
kind of get complacent with our coding

131
00:04:50,819 --> 00:04:52,040
and really

132
00:04:52,500 --> 00:04:53,000
continually

133
00:04:53,379 --> 00:04:55,939
documenting and advocating for what that code actually

134
00:04:55,939 --> 00:04:57,435
means. Yep. And,

135
00:04:58,295 --> 00:05:00,694
you know, if we look at 92507

136
00:05:00,694 --> 00:05:02,615
kind of at its core, when it was

137
00:05:02,615 --> 00:05:03,115
originally

138
00:05:04,134 --> 00:05:04,795
re revised,

139
00:05:05,254 --> 00:05:07,574
you know, fifteen years ago, it was looked

140
00:05:07,574 --> 00:05:10,214
at as a sixty minute code, more or

141
00:05:10,214 --> 00:05:12,099
less, but it was put in an untimed

142
00:05:12,099 --> 00:05:12,599
block.

143
00:05:12,899 --> 00:05:15,240
And it was really this catchall for everything

144
00:05:15,300 --> 00:05:16,439
we did because

145
00:05:17,379 --> 00:05:19,139
we didn't really define what we did very

146
00:05:19,139 --> 00:05:21,000
well, but we did a lot of things

147
00:05:21,060 --> 00:05:24,099
very well. But those definitions weren't really clear,

148
00:05:24,099 --> 00:05:26,439
so everything kinda went into this code and

149
00:05:26,845 --> 00:05:28,384
nobody's really touched it.

150
00:05:29,485 --> 00:05:32,285
We did have this time frame, which probably

151
00:05:32,285 --> 00:05:34,285
the last time anybody's gotten really heated about

152
00:05:34,285 --> 00:05:36,384
coding was about 2018.

153
00:05:37,245 --> 00:05:40,044
So we had and 2018 was really interesting

154
00:05:40,044 --> 00:05:43,000
especially in the cognitive spectrum because because that's

155
00:05:43,000 --> 00:05:44,600
when we had all of the revisions and

156
00:05:44,600 --> 00:05:45,100
deletions,

157
00:05:45,800 --> 00:05:47,240
09/1932

158
00:05:47,240 --> 00:05:49,560
and then that G01505.

159
00:05:49,560 --> 00:05:51,639
And then we had the replacement codes, but

160
00:05:51,639 --> 00:05:53,639
CMS didn't want them, so it was this

161
00:05:53,639 --> 00:05:55,365
back and forth. And that was the first

162
00:05:55,365 --> 00:05:58,485
time we had some really tangible timed codes

163
00:05:58,485 --> 00:05:59,224
come forward

164
00:05:59,845 --> 00:06:00,745
that were

165
00:06:01,125 --> 00:06:03,284
somewhat framed like PT and OT, but not

166
00:06:03,284 --> 00:06:04,964
really because that was a thirty minute code

167
00:06:04,964 --> 00:06:07,600
plus an additional 15, which is what we're

168
00:06:07,600 --> 00:06:10,160
potentially seeing coming out of some of these

169
00:06:10,160 --> 00:06:10,660
reviews.

170
00:06:12,000 --> 00:06:14,080
But we haven't really had to advocate for

171
00:06:14,080 --> 00:06:16,500
code or for a change in a while.

172
00:06:16,639 --> 00:06:17,759
So a lot of us are out of

173
00:06:17,759 --> 00:06:19,379
practice with it, and

174
00:06:20,104 --> 00:06:21,704
I think, you know, kind of getting back

175
00:06:21,704 --> 00:06:24,264
to those basics of, you know, how did

176
00:06:24,264 --> 00:06:25,084
we get here?

177
00:06:25,544 --> 00:06:28,425
What does this code change process mean? And

178
00:06:28,425 --> 00:06:31,324
what are the opportunities presented to us? Because

179
00:06:32,490 --> 00:06:32,990
when

180
00:06:33,449 --> 00:06:35,069
we talk about code changes,

181
00:06:36,970 --> 00:06:39,050
it's something you kind of once you get

182
00:06:39,050 --> 00:06:41,050
a good code, you kinda don't wanna touch

183
00:06:41,050 --> 00:06:41,550
it

184
00:06:41,930 --> 00:06:44,329
because we know anytime we touch coding in

185
00:06:44,329 --> 00:06:47,230
any aspect or any kind of billing revision,

186
00:06:47,634 --> 00:06:49,154
chances are we're gonna get a reduction in

187
00:06:49,154 --> 00:06:49,654
payment.

188
00:06:50,115 --> 00:06:53,714
And we've had this great opportunity with 92507

189
00:06:53,714 --> 00:06:55,714
where the payment's pretty good. We can put

190
00:06:55,714 --> 00:06:57,175
a lot of things into it.

191
00:06:57,955 --> 00:06:59,975
So opening up that code,

192
00:07:00,980 --> 00:07:02,740
while it's scary, there is a lot of

193
00:07:02,740 --> 00:07:04,819
opportunity, but chances are we are gonna see

194
00:07:04,819 --> 00:07:05,319
reductions

195
00:07:05,860 --> 00:07:07,639
on the surface of payment.

196
00:07:08,100 --> 00:07:10,740
But that doesn't mean everything is being reduced,

197
00:07:10,740 --> 00:07:12,740
and there is a lot of opportunity still

198
00:07:12,740 --> 00:07:14,500
out there because the value of the code

199
00:07:14,500 --> 00:07:16,935
hasn't been set. Thank you. That that is

200
00:07:17,014 --> 00:07:18,615
okay. So two things. I want you to,

201
00:07:18,615 --> 00:07:20,854
in a minute, introduce yourself so people know

202
00:07:20,854 --> 00:07:22,935
where you're talking from. But number two, that

203
00:07:22,935 --> 00:07:25,415
is the one main point I wanna get

204
00:07:25,415 --> 00:07:27,654
out of here is that people are seeing

205
00:07:27,654 --> 00:07:29,735
that this one code is now being reduced

206
00:07:29,735 --> 00:07:30,954
to $33,

207
00:07:31,569 --> 00:07:33,250
and that is not the full story at

208
00:07:33,250 --> 00:07:34,629
all. So go on that.

209
00:07:35,009 --> 00:07:36,470
Yeah. Yeah. So

210
00:07:36,850 --> 00:07:37,670
code submission,

211
00:07:38,290 --> 00:07:39,750
so right now so

212
00:07:40,449 --> 00:07:43,649
the rally relative value unit, our RBU. So

213
00:07:43,649 --> 00:07:46,665
there are some proposed numbers out there. AMA

214
00:07:46,665 --> 00:07:48,824
and the RUC, they don't set the payment.

215
00:07:48,824 --> 00:07:50,925
They don't set what that looks like. CMS

216
00:07:50,985 --> 00:07:52,985
ultimately is going to set that, but it's

217
00:07:52,985 --> 00:07:55,865
not a one and done. So when we

218
00:07:55,865 --> 00:07:56,764
look at

219
00:07:57,144 --> 00:08:00,125
kind of how payment is set and structured,

220
00:08:00,879 --> 00:08:02,080
and we see this happen a lot of

221
00:08:02,080 --> 00:08:04,400
times where the code isn't changed, but the

222
00:08:04,400 --> 00:08:07,779
payment structure is changed. So, essentially, what CMS

223
00:08:07,920 --> 00:08:09,759
does, and they do it almost on an

224
00:08:09,759 --> 00:08:13,120
annual basis, is they update the conversion factor

225
00:08:13,120 --> 00:08:16,185
factor. So that's something that goes into kind

226
00:08:16,185 --> 00:08:17,245
of the overall

227
00:08:17,545 --> 00:08:18,764
equation of the code.

228
00:08:19,144 --> 00:08:22,264
So, essentially, you have your end payment, but

229
00:08:22,264 --> 00:08:23,404
that's built between

230
00:08:23,865 --> 00:08:27,545
your RVU, your conversion factor, your CF, and

231
00:08:27,545 --> 00:08:29,324
your geographic adjustment

232
00:08:30,040 --> 00:08:33,100
plus any policy add ons or any adjustments

233
00:08:33,160 --> 00:08:34,220
with, like, your NC

234
00:08:34,679 --> 00:08:37,340
CI edits, or your modifier codes

235
00:08:37,799 --> 00:08:38,540
and also

236
00:08:39,000 --> 00:08:41,720
the order in which you code or how

237
00:08:41,720 --> 00:08:43,399
many codes you put on. So a lot

238
00:08:43,399 --> 00:08:44,779
of math goes into

239
00:08:45,304 --> 00:08:47,485
the end number or the end payment

240
00:08:48,024 --> 00:08:50,524
and that's just on the Medicare side.

241
00:08:50,904 --> 00:08:53,144
We also have all of those same things

242
00:08:53,144 --> 00:08:55,865
happening for every single MAC, every single local

243
00:08:55,865 --> 00:08:56,764
coverage determination,

244
00:08:57,500 --> 00:09:00,620
every single insurance payer, all of our Medicaid

245
00:09:00,620 --> 00:09:02,799
payers, and all of those are different

246
00:09:03,179 --> 00:09:05,039
per setting and per state.

247
00:09:05,899 --> 00:09:07,839
So when we see kind of this

248
00:09:08,139 --> 00:09:09,679
number that's coming out initially,

249
00:09:10,134 --> 00:09:12,454
that's not the end number. That's kind of

250
00:09:12,454 --> 00:09:14,315
our our starting base

251
00:09:15,414 --> 00:09:17,495
plus all of these modifiers and all of

252
00:09:17,495 --> 00:09:18,315
these multiplications

253
00:09:18,694 --> 00:09:20,855
to get the end payment. And it's gonna

254
00:09:20,855 --> 00:09:22,714
look different across the board.

255
00:09:23,450 --> 00:09:26,190
So that's why as, you know, speech pathologists,

256
00:09:26,250 --> 00:09:28,009
as you were saying, we practice across a

257
00:09:28,009 --> 00:09:28,830
vast setting

258
00:09:29,210 --> 00:09:30,269
with a

259
00:09:30,730 --> 00:09:33,149
vast difference of patient population.

260
00:09:33,769 --> 00:09:36,429
So upfront, really getting that

261
00:09:37,205 --> 00:09:37,705
RVU

262
00:09:38,565 --> 00:09:40,725
looked at of what does the value of

263
00:09:40,725 --> 00:09:43,625
this code look like. And that doesn't mean

264
00:09:43,684 --> 00:09:44,184
numerically

265
00:09:44,644 --> 00:09:46,565
what does this value look like. We wanna

266
00:09:46,565 --> 00:09:49,125
be talking about the structure of the code.

267
00:09:49,125 --> 00:09:50,585
We wanna be talking about

268
00:09:51,129 --> 00:09:53,929
the workflow, the system logistics within it, the

269
00:09:53,929 --> 00:09:56,009
clinical logic of how we get to these

270
00:09:56,009 --> 00:09:58,110
code sets. So really giving

271
00:09:59,209 --> 00:10:02,250
definition to all of the clinical complexities that

272
00:10:02,250 --> 00:10:04,029
go into the structure of this code,

273
00:10:04,634 --> 00:10:07,434
and that starts to build that value and

274
00:10:07,434 --> 00:10:10,175
that starting base. Then all of those modifiers

275
00:10:10,235 --> 00:10:11,835
are added onto it and all of those

276
00:10:11,835 --> 00:10:12,335
multipliers.

277
00:10:13,274 --> 00:10:13,774
So,

278
00:10:15,195 --> 00:10:17,134
we talk about, like, what is our opportunity

279
00:10:17,355 --> 00:10:18,095
right now,

280
00:10:18,554 --> 00:10:19,054
and

281
00:10:19,659 --> 00:10:20,720
a lot of people

282
00:10:21,019 --> 00:10:22,779
you know, we talk about, okay. Let's advocate

283
00:10:22,779 --> 00:10:24,799
for the code. Let's advocate for the change.

284
00:10:25,899 --> 00:10:27,820
But are you involved in the process? Do

285
00:10:27,820 --> 00:10:29,840
you even know what that process looks like?

286
00:10:30,139 --> 00:10:31,659
So I would one of the first things

287
00:10:31,659 --> 00:10:34,285
I would challenge everybody who's listening and challenge

288
00:10:34,285 --> 00:10:36,125
you to talk to your SLP friends about

289
00:10:36,125 --> 00:10:38,065
it is, are you registered

290
00:10:38,764 --> 00:10:41,825
for the next meeting? Are you registered for

291
00:10:41,884 --> 00:10:44,705
the upcoming CPT editorial panel review?

292
00:10:45,039 --> 00:10:46,879
We're we're on the spot right now. It's

293
00:10:47,039 --> 00:10:49,679
the registration's open right now. So, if you're

294
00:10:49,679 --> 00:10:51,440
listening to this, I would encourage every single

295
00:10:51,440 --> 00:10:53,519
one of you, go on to the AMA

296
00:10:53,519 --> 00:10:54,019
website,

297
00:10:54,720 --> 00:10:57,360
get registered for the editorial panel meeting. The

298
00:10:57,360 --> 00:10:59,460
meeting is April 30. And

299
00:10:59,795 --> 00:11:02,274
in order to get any insight, in order

300
00:11:02,274 --> 00:11:03,955
to get any of the meeting minutes, the

301
00:11:03,955 --> 00:11:06,035
notes, all of that nitty gritty stuff, you

302
00:11:06,035 --> 00:11:08,035
have to be registered. They're not just gonna

303
00:11:08,035 --> 00:11:09,555
send it out to you. It's not gonna

304
00:11:09,555 --> 00:11:12,115
be publicly made information for quite some time.

305
00:11:12,115 --> 00:11:14,035
But if you're registered and you're attending those

306
00:11:14,035 --> 00:11:14,535
meetings,

307
00:11:15,309 --> 00:11:16,990
you're gonna get some of the information. You're

308
00:11:16,990 --> 00:11:17,970
gonna get a chance

309
00:11:18,350 --> 00:11:18,850
potentially

310
00:11:19,309 --> 00:11:22,050
to speak up about what the value

311
00:11:22,750 --> 00:11:24,529
of all of these codes are.

312
00:11:26,029 --> 00:11:27,164
And the reality is

313
00:11:27,644 --> 00:11:30,284
what we've historically seen is when a code

314
00:11:30,284 --> 00:11:32,524
is identified as a high use code, like

315
00:11:32,524 --> 00:11:33,644
92507

316
00:11:33,644 --> 00:11:34,144
was,

317
00:11:35,485 --> 00:11:36,625
we're gonna see revisions.

318
00:11:37,084 --> 00:11:38,764
Whether that's going to be a revision in

319
00:11:38,764 --> 00:11:40,625
the definition of the code and the payment

320
00:11:40,839 --> 00:11:43,000
or a new code set, which we've seen

321
00:11:43,000 --> 00:11:46,279
multiple proposals of, different code sets going through

322
00:11:46,279 --> 00:11:46,779
here.

323
00:11:48,120 --> 00:11:49,960
But this is our chance to come forth

324
00:11:49,960 --> 00:11:50,700
and say

325
00:11:51,799 --> 00:11:52,620
and really

326
00:11:53,644 --> 00:11:56,524
advocate for why these codes are so important

327
00:11:56,524 --> 00:11:58,304
and the complexities of them.

328
00:11:59,004 --> 00:12:02,044
It's a great opportunity for us. Individuals who

329
00:12:02,044 --> 00:12:04,684
have started looking at some of the revised

330
00:12:04,684 --> 00:12:05,504
code structure

331
00:12:06,044 --> 00:12:06,544
proposals

332
00:12:07,340 --> 00:12:09,500
have already identified, okay, we're missing some key

333
00:12:09,500 --> 00:12:10,799
elements here. Yep.

334
00:12:11,340 --> 00:12:11,840
So

335
00:12:12,700 --> 00:12:13,980
that's what we need to be doing. We

336
00:12:13,980 --> 00:12:15,419
need to be saying, like, this code is

337
00:12:15,419 --> 00:12:17,100
really complex. Nine two five zero seven is

338
00:12:17,100 --> 00:12:18,720
a very complex code.

339
00:12:19,514 --> 00:12:21,035
And when I bill nine two five zero

340
00:12:21,035 --> 00:12:23,115
seven, I'm not treating the same thing that

341
00:12:23,115 --> 00:12:25,355
my pediatric friends are treating. I'm not treating

342
00:12:25,355 --> 00:12:27,035
the same thing that my outpatient friends are

343
00:12:27,035 --> 00:12:29,514
treating. I'm not treating the same thing as

344
00:12:29,514 --> 00:12:31,215
my home health patients are seeing.

345
00:12:31,870 --> 00:12:33,389
And we need to be able to put

346
00:12:33,389 --> 00:12:35,950
that dialogue and put that clinical complexity and

347
00:12:35,950 --> 00:12:37,170
skill into words

348
00:12:37,790 --> 00:12:39,790
and present it to the panel to say

349
00:12:39,790 --> 00:12:41,889
this is complex. Yeah. It's not

350
00:12:42,429 --> 00:12:44,504
just a one size fits all. Yeah. I

351
00:12:44,504 --> 00:12:46,105
I remember when I was fresh out of

352
00:12:46,105 --> 00:12:48,745
grad school. Right? You know? And I barely

353
00:12:48,745 --> 00:12:51,225
even had any medical SLP training at all

354
00:12:51,225 --> 00:12:52,504
in grad school, and and I and I

355
00:12:52,504 --> 00:12:54,264
don't say that to shame a grad program.

356
00:12:54,264 --> 00:12:56,264
It was just it it was the reality

357
00:12:56,264 --> 00:12:58,264
of I had a very pediatric focused grad

358
00:12:58,264 --> 00:13:00,639
program. That being said, I ended up loving

359
00:13:00,639 --> 00:13:03,360
the sniff setting. And I just had a,

360
00:13:03,360 --> 00:13:06,159
you know, wonderful director rehab who just said,

361
00:13:06,159 --> 00:13:08,080
you know, these are your codes. If you're

362
00:13:08,080 --> 00:13:10,639
doing speech or language, bill 9 2507.

363
00:13:10,639 --> 00:13:13,120
If you're doing swallowing, bill 9 2526. And

364
00:13:13,120 --> 00:13:13,700
I just

365
00:13:14,004 --> 00:13:16,164
was a Yep. Good little SLP and did

366
00:13:16,164 --> 00:13:17,764
what I was told and went and saw

367
00:13:17,764 --> 00:13:19,845
patients and billed those codes and just never

368
00:13:19,845 --> 00:13:21,605
thought about it. Right? And it really wasn't

369
00:13:21,605 --> 00:13:22,345
even till,

370
00:13:22,964 --> 00:13:24,725
I don't know, many years later, I'm ashamed

371
00:13:24,725 --> 00:13:26,404
to say. And I was having a conversation

372
00:13:26,404 --> 00:13:27,580
with, you know, one of my friends, and

373
00:13:27,580 --> 00:13:28,540
I was like, well, tell me, you know,

374
00:13:28,540 --> 00:13:30,139
like, what codes do you bill? Because I

375
00:13:30,139 --> 00:13:32,620
I had started doing some own digging myself,

376
00:13:32,620 --> 00:13:33,740
and I was like, why are there all

377
00:13:33,740 --> 00:13:35,360
these other codes in here that

378
00:13:35,740 --> 00:13:38,139
we're not billing? Like and it wasn't it

379
00:13:38,139 --> 00:13:39,455
it just sparked a lot of interest in

380
00:13:39,455 --> 00:13:40,495
me, and I was like, what do you

381
00:13:40,495 --> 00:13:42,754
bill? And she she only sees

382
00:13:43,774 --> 00:13:45,154
she sees really complex

383
00:13:45,535 --> 00:13:47,855
pediatric cases, and she's like, oh, I bill

384
00:13:47,855 --> 00:13:48,815
92507.

385
00:13:48,815 --> 00:13:50,495
I was like, wait. That's what I bill

386
00:13:50,495 --> 00:13:52,409
in the nursing home. Like, and to me,

387
00:13:52,409 --> 00:13:54,250
I was like, that's insane, like, that there

388
00:13:54,250 --> 00:13:56,330
was so much overlap on that. I mean,

389
00:13:56,330 --> 00:13:58,009
even that was probably ten years ago that

390
00:13:58,009 --> 00:13:59,470
I had those conversations. But

391
00:13:59,929 --> 00:14:01,450
all that said, I wanna stop right here,

392
00:14:01,450 --> 00:14:03,610
Lisa. I want you to introduce yourself and

393
00:14:03,610 --> 00:14:05,764
share your background. I we this this is

394
00:14:05,764 --> 00:14:06,964
just like a movie. We just gave you

395
00:14:06,964 --> 00:14:08,485
guys the preview, and now we're gonna introduce

396
00:14:08,485 --> 00:14:10,565
the cast. Okay? So go ahead, Lisa. Share

397
00:14:10,565 --> 00:14:11,384
who you are.

398
00:14:12,084 --> 00:14:12,584
Okay.

399
00:14:12,964 --> 00:14:15,204
I'm Lisa Johnson. I am a speech language

400
00:14:15,204 --> 00:14:15,704
pathologist.

401
00:14:16,164 --> 00:14:19,125
I work, kind of a cross continuum in

402
00:14:19,125 --> 00:14:20,184
the adult and geriatric

403
00:14:20,940 --> 00:14:22,620
sector. I spend a lot of my time

404
00:14:22,620 --> 00:14:24,399
in regulatory compliance,

405
00:14:24,940 --> 00:14:25,840
program development,

406
00:14:26,940 --> 00:14:29,360
audits and denials across the continuum.

407
00:14:29,820 --> 00:14:31,360
I work in a six state region,

408
00:14:31,740 --> 00:14:34,774
so multiple local coverage determinations in that that

409
00:14:34,774 --> 00:14:37,595
I'm dealing with. I'm actually in the Midwest,

410
00:14:37,735 --> 00:14:39,575
and so I see and spend a lot

411
00:14:39,575 --> 00:14:41,434
of my time working with

412
00:14:41,815 --> 00:14:44,235
managed care, private care insurance, payment,

413
00:14:44,855 --> 00:14:48,000
really digging into those aspects. I've been working

414
00:14:48,700 --> 00:14:51,660
primarily in senior care and geriatrics for over

415
00:14:51,660 --> 00:14:54,620
fifteen years now. This is my my happy

416
00:14:54,620 --> 00:14:55,100
place.

417
00:14:55,740 --> 00:14:57,980
I'm I'm kinda the point person when there's

418
00:14:57,980 --> 00:15:00,860
coding changes, when there's rumblings about different things

419
00:15:00,860 --> 00:15:01,840
within our organization,

420
00:15:02,375 --> 00:15:04,214
really digging into that nitty gritty.

421
00:15:04,695 --> 00:15:06,475
I get excited with the numbers.

422
00:15:07,575 --> 00:15:10,214
I'm kind of the numbers nerd, so that's

423
00:15:10,214 --> 00:15:11,975
me in a nutshell. Yes. Thank you. Thank

424
00:15:11,975 --> 00:15:13,414
you for sharing that. I I just wanted

425
00:15:13,414 --> 00:15:15,779
everyone to know that you this is truly

426
00:15:15,779 --> 00:15:17,620
all you eat, sleep, and breathe. So so

427
00:15:17,620 --> 00:15:19,700
thank you for that. Yeah. Okay. So let's,

428
00:15:19,940 --> 00:15:21,940
let's back up a little bit. Let's dive

429
00:15:21,940 --> 00:15:22,440
into

430
00:15:22,980 --> 00:15:25,320
all the different players at play,

431
00:15:25,700 --> 00:15:28,024
because I there's so much complexity in that.

432
00:15:28,024 --> 00:15:29,865
And and to be honest, that was just

433
00:15:29,865 --> 00:15:31,725
nothing that I had ever learned until

434
00:15:32,184 --> 00:15:34,584
I started opening a clinic and learned all

435
00:15:34,584 --> 00:15:36,584
about it myself. And, you know, it's one

436
00:15:36,584 --> 00:15:38,105
of those things that it's like SLP should

437
00:15:38,105 --> 00:15:39,704
learn this stuff. Yeah. We should. And I

438
00:15:39,704 --> 00:15:41,225
and I don't know where this belongs. I

439
00:15:41,225 --> 00:15:43,690
don't know if it's something that really needs

440
00:15:43,690 --> 00:15:45,210
to be taught in grad school or or

441
00:15:45,210 --> 00:15:46,889
how we learn this stuff, but it is

442
00:15:46,889 --> 00:15:48,809
so important to know. And you should know

443
00:15:48,809 --> 00:15:50,350
these things because they do

444
00:15:51,129 --> 00:15:53,290
impact everything that we do. They impact our

445
00:15:53,290 --> 00:15:54,110
service delivery.

446
00:15:54,730 --> 00:15:56,570
They there's just so much that goes into

447
00:15:56,570 --> 00:15:59,304
it. So Definitely. Definitely. So, you know, I'll

448
00:15:59,304 --> 00:16:00,284
try and keep it

449
00:16:00,664 --> 00:16:03,225
as simple as possible because it is very,

450
00:16:03,225 --> 00:16:05,304
very complex when we're talking about coding and

451
00:16:05,304 --> 00:16:06,204
billing and reimbursement.

452
00:16:07,225 --> 00:16:09,544
So kinda to start with AMA, so the

453
00:16:09,544 --> 00:16:10,684
American Medical Association,

454
00:16:11,279 --> 00:16:11,779
That's

455
00:16:12,240 --> 00:16:14,659
who creates our CPT codes and,

456
00:16:15,279 --> 00:16:17,539
looks at really the structure of the codes.

457
00:16:17,919 --> 00:16:21,679
They manage code creation, revision, deletion, description of

458
00:16:21,679 --> 00:16:24,959
the code, and instructional guidelines. And that's kind

459
00:16:24,959 --> 00:16:25,620
of where

460
00:16:26,174 --> 00:16:28,894
AMA and CPT end. They kinda own the

461
00:16:28,894 --> 00:16:30,674
coding and what it looks like.

462
00:16:31,455 --> 00:16:34,335
Then we have CMS, so Center of Medicare

463
00:16:34,335 --> 00:16:36,975
and Medicaid Services. They don't create the codes.

464
00:16:36,975 --> 00:16:39,179
Sometimes they do some interesting things with codes,

465
00:16:39,419 --> 00:16:42,240
but they decide how how the codes are

466
00:16:42,299 --> 00:16:44,639
valued and paid under Medicare.

467
00:16:45,259 --> 00:16:48,059
So what that looks like is once a

468
00:16:48,059 --> 00:16:50,320
code is more or less approved

469
00:16:50,940 --> 00:16:54,415
by AMA and the CPT editorial committee and

470
00:16:54,415 --> 00:16:55,154
goes into

471
00:16:55,615 --> 00:16:56,195
the revision,

472
00:16:57,455 --> 00:17:00,254
which that itself is a huge process, and

473
00:17:00,254 --> 00:17:01,695
that's kind of where we're sitting right now

474
00:17:01,695 --> 00:17:02,595
with these codes.

475
00:17:03,855 --> 00:17:06,015
If the code is approved, if the code

476
00:17:06,015 --> 00:17:07,234
is basically

477
00:17:08,359 --> 00:17:09,420
planned for publishing,

478
00:17:10,680 --> 00:17:13,740
then CMS steps in. So after AMA approval,

479
00:17:14,119 --> 00:17:16,920
code goes through what's called a valuation review,

480
00:17:16,920 --> 00:17:18,380
and that's done by CMS.

481
00:17:19,080 --> 00:17:22,440
And CMS starts determining the relative value units

482
00:17:22,440 --> 00:17:23,259
or the RBUs,

483
00:17:23,755 --> 00:17:26,174
the payment amounts, the coverage policies,

484
00:17:26,714 --> 00:17:29,294
the frequency edits associated with them,

485
00:17:29,595 --> 00:17:30,494
and the documentation

486
00:17:30,875 --> 00:17:31,375
expectations.

487
00:17:32,315 --> 00:17:33,694
They will look at recommendations

488
00:17:34,315 --> 00:17:34,815
from

489
00:17:35,355 --> 00:17:37,855
AMA's RUC or relative value

490
00:17:38,779 --> 00:17:39,980
scale update committee,

491
00:17:41,740 --> 00:17:42,240
and

492
00:17:42,700 --> 00:17:45,519
really look at what's going into the code,

493
00:17:46,220 --> 00:17:48,619
how is the code valued from kind of

494
00:17:48,619 --> 00:17:51,500
a clinical complexity standpoint, and then they'll compare

495
00:17:51,500 --> 00:17:52,799
it to other code structures.

496
00:17:53,535 --> 00:17:54,035
Then

497
00:17:54,335 --> 00:17:56,275
they're also going to look at,

498
00:17:58,335 --> 00:17:58,835
basically,

499
00:17:59,295 --> 00:18:01,555
some of the other players coming in is

500
00:18:01,855 --> 00:18:03,394
is the code budget neutral?

501
00:18:04,335 --> 00:18:07,134
Is this for a specific setting, for a

502
00:18:07,134 --> 00:18:09,330
specific region? So you continue to have all

503
00:18:09,330 --> 00:18:10,230
of these shifting

504
00:18:10,930 --> 00:18:11,829
coverage determinations.

505
00:18:12,450 --> 00:18:15,589
Then your local coverage determination comes in. So

506
00:18:15,809 --> 00:18:17,730
AMA has said, here's the code. CMS has

507
00:18:17,730 --> 00:18:19,170
said, here's how we think we're gonna pay

508
00:18:19,170 --> 00:18:21,190
for the code, then the local coverage determination,

509
00:18:22,454 --> 00:18:24,075
kind of run by your max,

510
00:18:24,615 --> 00:18:26,454
are gonna say, here's the rules we're gonna

511
00:18:26,454 --> 00:18:29,015
accept within this structure that we're gonna say

512
00:18:29,015 --> 00:18:31,095
yes or no on, and then we may

513
00:18:31,095 --> 00:18:33,654
or may not add some additional revisions to

514
00:18:33,654 --> 00:18:35,519
it or some additional

515
00:18:35,820 --> 00:18:37,500
modifiers that you have to have or maybe

516
00:18:37,500 --> 00:18:39,259
diagnostic codes that you have to have with

517
00:18:39,259 --> 00:18:41,339
it. So you're starting to see the split

518
00:18:41,339 --> 00:18:43,599
as we go across the country with that.

519
00:18:45,420 --> 00:18:48,059
Once that happens, and sometimes it happens in

520
00:18:48,059 --> 00:18:49,920
tandem, you also have Medicaid

521
00:18:50,595 --> 00:18:53,315
running their same parallel, and sometimes they get

522
00:18:53,315 --> 00:18:55,474
ahead of CMS. Sometimes they're a little bit

523
00:18:55,474 --> 00:18:56,775
behind. We're seeing some

524
00:18:57,234 --> 00:18:59,315
areas where Medicaid is ahead of CMS right

525
00:18:59,315 --> 00:19:00,454
now with this structure.

526
00:19:00,994 --> 00:19:03,554
And they will say, okay. Well, that's great

527
00:19:03,554 --> 00:19:05,234
that you have that code. We're gonna add

528
00:19:05,234 --> 00:19:07,619
all of these revisions to it, and we're

529
00:19:07,619 --> 00:19:09,559
gonna add all of these additional requirements.

530
00:19:10,339 --> 00:19:12,419
Or we're gonna say that you can use

531
00:19:12,419 --> 00:19:14,179
this code, but only if you add this

532
00:19:14,179 --> 00:19:14,679
modifier.

533
00:19:15,460 --> 00:19:17,539
And if you hit this time frame, it's

534
00:19:17,539 --> 00:19:19,940
gonna be multiplied by this much or divided

535
00:19:19,940 --> 00:19:22,295
by this much. So, again, modifying what we're

536
00:19:22,295 --> 00:19:23,434
paid at the end.

537
00:19:24,214 --> 00:19:26,934
Then while that's all happening, the other person

538
00:19:26,934 --> 00:19:29,914
or other entities playing into it are

539
00:19:30,375 --> 00:19:32,634
are managed care or our private care insurances,

540
00:19:33,734 --> 00:19:34,234
our

541
00:19:34,799 --> 00:19:37,940
advantage plans. So think like Humana Blue Cross,

542
00:19:39,200 --> 00:19:40,900
Aetna, all of those insurances.

543
00:19:41,360 --> 00:19:42,820
They're also going to take

544
00:19:43,120 --> 00:19:45,279
what the MACs and the LCDs said, and

545
00:19:45,279 --> 00:19:47,840
they're gonna say, okay. That's great. Here's our

546
00:19:47,840 --> 00:19:48,340
interpretation.

547
00:19:49,565 --> 00:19:51,644
And we may or may not accept what

548
00:19:51,644 --> 00:19:52,944
Medicare said.

549
00:19:53,244 --> 00:19:55,484
We may or may not accept that as

550
00:19:55,484 --> 00:19:57,884
the billing rate. Or we might say, yeah.

551
00:19:57,884 --> 00:19:59,404
You know, we don't really want that code.

552
00:19:59,404 --> 00:20:01,164
You can keep using this old one because

553
00:20:01,164 --> 00:20:03,105
we liked how easy it was to audit.

554
00:20:04,190 --> 00:20:06,269
So you have all of these players coming

555
00:20:06,269 --> 00:20:07,250
in, and

556
00:20:08,269 --> 00:20:10,210
it's it's very confusing.

557
00:20:11,630 --> 00:20:13,390
And and that's just kind of like that

558
00:20:13,390 --> 00:20:15,410
high level. Yeah. And

559
00:20:16,375 --> 00:20:17,595
it's going to impact

560
00:20:18,054 --> 00:20:19,974
also, you know, if you have different policies

561
00:20:19,974 --> 00:20:20,954
within your organization

562
00:20:21,414 --> 00:20:23,335
at state level. You have different rules and

563
00:20:23,335 --> 00:20:24,954
regulations based on your licensure

564
00:20:25,255 --> 00:20:27,994
depending on what state you're in, depending on

565
00:20:28,375 --> 00:20:31,369
what billers your organization or your private pack

566
00:20:31,529 --> 00:20:33,950
practice accepts where you're allowed to bill.

567
00:20:35,529 --> 00:20:36,029
So

568
00:20:36,410 --> 00:20:38,109
a lot of things impact

569
00:20:38,730 --> 00:20:41,065
the end result of the code. So there's

570
00:20:41,065 --> 00:20:42,825
a lot of rules for us to know,

571
00:20:43,144 --> 00:20:45,705
and I wouldn't expect any one SLP to

572
00:20:45,705 --> 00:20:47,484
be like, I know all of the rules.

573
00:20:47,865 --> 00:20:48,605
But at least

574
00:20:49,225 --> 00:20:51,465
my kind of expectation or kind of expectation

575
00:20:51,465 --> 00:20:52,984
I bring forth to our team, I say,

576
00:20:52,984 --> 00:20:54,265
you need to know where to look for

577
00:20:54,265 --> 00:20:54,924
the rules,

578
00:20:55,579 --> 00:20:57,599
and you need to know what rules impact

579
00:20:57,900 --> 00:21:00,380
your area that you're facing. That was that

580
00:21:00,380 --> 00:21:02,240
was gonna be my next question is,

581
00:21:04,059 --> 00:21:06,539
Suzy Staff SLP. I'm making the absolute most

582
00:21:06,539 --> 00:21:08,539
largest generalization ever in the world right now,

583
00:21:08,539 --> 00:21:10,160
everyone. Okay. Don't come for me.

584
00:21:10,505 --> 00:21:11,644
Susie Staff SLP

585
00:21:11,945 --> 00:21:14,105
loves to just get her kids on the

586
00:21:14,105 --> 00:21:16,265
bus in the morning, grab her coffee, get

587
00:21:16,265 --> 00:21:18,664
to work, see eight patients a day, clock

588
00:21:18,664 --> 00:21:20,904
out, go home. It's the most perfect life.

589
00:21:20,904 --> 00:21:22,985
She loves it. She does not wanna know

590
00:21:22,985 --> 00:21:25,305
this stuff. What is the minimum amount of

591
00:21:25,305 --> 00:21:26,500
stuff that she

592
00:21:26,880 --> 00:21:29,440
could know to still feel good about what

593
00:21:29,440 --> 00:21:31,700
she's doing, know that she's ethically billing,

594
00:21:32,080 --> 00:21:34,500
know that she's doing right by the facility

595
00:21:34,559 --> 00:21:36,960
and bringing in the right reimbursements that need

596
00:21:36,960 --> 00:21:37,539
to happen?

597
00:21:38,025 --> 00:21:40,664
So kind of kind of bare minimum that

598
00:21:40,664 --> 00:21:43,384
I and, again, this is my personal lived

599
00:21:43,384 --> 00:21:45,965
experience because I I've been the SLP who

600
00:21:46,025 --> 00:21:48,345
who shows up, and I enter the billing

601
00:21:48,345 --> 00:21:49,164
codes that

602
00:21:49,705 --> 00:21:51,484
are auto populated in my EMR

603
00:21:51,865 --> 00:21:52,365
and,

604
00:21:52,880 --> 00:21:55,360
you know, the whatever treatment was assigned, like,

605
00:21:55,360 --> 00:21:57,539
I go and treat and I do. And

606
00:21:58,000 --> 00:22:00,240
that that's fine and dandy, but you're putting

607
00:22:00,240 --> 00:22:01,920
yourself at risk and you're doing a disservice

608
00:22:01,920 --> 00:22:04,160
to yourself, our profession, and your patients if

609
00:22:04,160 --> 00:22:06,640
you do that. So at a minimum, I

610
00:22:06,640 --> 00:22:07,380
would say,

611
00:22:08,455 --> 00:22:09,755
at the beginning of every year,

612
00:22:10,215 --> 00:22:12,535
open up that new physician fee schedule. ASHA

613
00:22:12,535 --> 00:22:14,695
does a great job of preparing one that

614
00:22:14,695 --> 00:22:17,575
is very speech specific with amazing links and

615
00:22:17,575 --> 00:22:20,775
resources within ASHA and outside of it. But

616
00:22:20,775 --> 00:22:21,595
at a minimum,

617
00:22:22,019 --> 00:22:24,420
have that position fee schedule for the current

618
00:22:24,420 --> 00:22:25,480
year you're in,

619
00:22:25,779 --> 00:22:26,519
go through,

620
00:22:26,980 --> 00:22:28,119
highlight the codes

621
00:22:28,740 --> 00:22:30,340
that are ones that you use in your

622
00:22:30,340 --> 00:22:30,840
practice

623
00:22:31,859 --> 00:22:34,519
and ones that you have questions about.

624
00:22:35,284 --> 00:22:37,944
So, you know, we talk about 92507,

625
00:22:38,404 --> 00:22:40,565
kind of that catch all code. Do you

626
00:22:40,565 --> 00:22:42,664
do anything else that's not in that description,

627
00:22:44,005 --> 00:22:46,744
or is that description broad enough for you?

628
00:22:47,140 --> 00:22:49,140
And start breaking down what you do, really

629
00:22:49,140 --> 00:22:49,640
understanding,

630
00:22:50,419 --> 00:22:53,079
okay, if I am treating somebody for apraxia,

631
00:22:53,299 --> 00:22:55,160
what does that mean? Does my documentation

632
00:22:55,619 --> 00:22:56,119
support

633
00:22:56,500 --> 00:22:58,740
I am treating apraxia? Here's what I'm doing.

634
00:22:58,740 --> 00:22:59,960
Here's the skilled things.

635
00:23:00,345 --> 00:23:02,345
Versus the next day, I see that person

636
00:23:02,345 --> 00:23:04,125
and maybe I'm treating aphasia.

637
00:23:05,544 --> 00:23:07,404
What am I treating? What is the skill?

638
00:23:07,544 --> 00:23:11,065
And getting really good at breaking down and

639
00:23:11,065 --> 00:23:11,565
documenting,

640
00:23:12,184 --> 00:23:14,684
even though it's all within one code, perhaps,

641
00:23:16,169 --> 00:23:18,329
This is the skill and this is the

642
00:23:18,329 --> 00:23:19,389
clinical complexity

643
00:23:20,089 --> 00:23:23,130
that I'm treating. And when you review your

644
00:23:23,130 --> 00:23:24,990
documentation, I recommend that our SLPs

645
00:23:25,769 --> 00:23:27,609
audit your own documentation. Like, look at your

646
00:23:27,609 --> 00:23:29,769
last thirty days. If 90% of your billing

647
00:23:29,769 --> 00:23:31,149
is $92.05 $0.07,

648
00:23:31,234 --> 00:23:32,994
you should be able to tell that those

649
00:23:32,994 --> 00:23:34,535
are different treatment sessions,

650
00:23:34,914 --> 00:23:38,275
different diagnostics that you're treating, different deficits and

651
00:23:38,275 --> 00:23:38,775
impairments.

652
00:23:39,474 --> 00:23:42,375
It shouldn't read like everybody looks the same.

653
00:23:42,515 --> 00:23:43,015
Right.

654
00:23:43,650 --> 00:23:44,390
And I think,

655
00:23:44,690 --> 00:23:47,570
you know, at a minimum as SLPs, we

656
00:23:47,570 --> 00:23:49,269
need to know our physician fee schedule.

657
00:23:49,570 --> 00:23:51,009
We need to know what codes are available,

658
00:23:51,009 --> 00:23:53,430
whether you use them or not. Right. Right.

659
00:23:53,490 --> 00:23:56,289
Know what's available, but know the definition of

660
00:23:56,289 --> 00:23:58,664
what you're using. If you're using a code,

661
00:23:58,724 --> 00:24:00,005
you need to be able to define that

662
00:24:00,005 --> 00:24:00,505
code

663
00:24:01,365 --> 00:24:03,365
and know what the rules are associated with

664
00:24:03,365 --> 00:24:06,325
it. So so say someone's having trouble getting

665
00:24:06,325 --> 00:24:09,144
this info from their DOR or their facility,

666
00:24:09,684 --> 00:24:11,845
who can they contact to figure out what

667
00:24:11,845 --> 00:24:13,019
exactly they're able to bill?

668
00:24:14,059 --> 00:24:16,299
So kind of first start with that position

669
00:24:16,299 --> 00:24:18,480
fee schedule. You can go on,

670
00:24:19,580 --> 00:24:21,900
go online. You can search for it. If

671
00:24:21,900 --> 00:24:24,619
you just search twenty twenty six position fee

672
00:24:24,619 --> 00:24:25,599
schedule SLP,

673
00:24:26,554 --> 00:24:28,394
generally, the first thing that pops up is

674
00:24:28,394 --> 00:24:30,954
the PDF from ASHA that has all of

675
00:24:30,954 --> 00:24:32,335
those physician fee schedules.

676
00:24:33,035 --> 00:24:34,414
Next thing, just

677
00:24:34,954 --> 00:24:36,015
ask your DOR

678
00:24:36,714 --> 00:24:38,335
what insurances do we bill.

679
00:24:39,590 --> 00:24:42,970
Start there. If you are seeing straight traditional

680
00:24:43,029 --> 00:24:43,769
med a,

681
00:24:44,150 --> 00:24:46,710
k, pull the CMS manual and the local

682
00:24:46,710 --> 00:24:48,890
coverage determination for your area.

683
00:24:49,670 --> 00:24:51,049
That'll give you the rules.

684
00:24:51,394 --> 00:24:53,554
Those are also PDF files you can type

685
00:24:53,554 --> 00:24:56,034
in in a search area what code, and

686
00:24:56,034 --> 00:24:57,954
it'll tell you all the rules associated with

687
00:24:57,954 --> 00:25:00,194
that code. I will also add the AI

688
00:25:00,194 --> 00:25:02,674
is very helpful for doing this. Like, I've

689
00:25:02,674 --> 00:25:04,375
typed in a few different codes

690
00:25:04,730 --> 00:25:06,809
in this area. I'm in North Florida. In

691
00:25:06,809 --> 00:25:08,570
Florida, we have North Florida. We have South

692
00:25:08,570 --> 00:25:10,029
Florida. Those are the two different

693
00:25:10,410 --> 00:25:12,670
two different MACs, but then there are geographic

694
00:25:13,210 --> 00:25:15,369
things as well. And what's interesting is just

695
00:25:15,369 --> 00:25:17,210
there's some codes that can be built a

696
00:25:17,210 --> 00:25:19,130
few counties over. There's some that can't be

697
00:25:19,130 --> 00:25:20,349
built. There's so

698
00:25:20,835 --> 00:25:22,674
much variation, and that's just what I wanna

699
00:25:22,674 --> 00:25:23,174
emphasize

700
00:25:23,634 --> 00:25:25,234
to you guys is I'm just giving so

701
00:25:25,234 --> 00:25:26,375
many blanket recommendations

702
00:25:26,835 --> 00:25:29,654
online for people to research this stuff because

703
00:25:30,194 --> 00:25:31,575
everybody is so different.

704
00:25:32,194 --> 00:25:33,174
Yeah. And, usually,

705
00:25:33,474 --> 00:25:34,294
it's interesting.

706
00:25:34,595 --> 00:25:35,095
So

707
00:25:35,539 --> 00:25:36,899
when I was, you know, when I was

708
00:25:36,899 --> 00:25:37,799
a staff therapist,

709
00:25:38,899 --> 00:25:40,519
my DOR was a PT.

710
00:25:41,140 --> 00:25:43,539
So me coming up and saying, hey. How

711
00:25:43,539 --> 00:25:45,159
do you build this? They'd be like,

712
00:25:46,579 --> 00:25:48,339
Right. You have an end time code? That

713
00:25:48,419 --> 00:25:50,339
like, it we're not even speaking the same

714
00:25:50,339 --> 00:25:50,839
language.

715
00:25:51,434 --> 00:25:53,694
So, you know, if you're in an area

716
00:25:53,755 --> 00:25:55,294
or you're in an organization

717
00:25:55,755 --> 00:25:57,375
where you have a biller,

718
00:25:58,634 --> 00:26:00,654
maybe your health information person,

719
00:26:00,954 --> 00:26:03,454
if you're in skilled nursing, your MDS person

720
00:26:03,755 --> 00:26:06,154
Yep. They know a lot about coding and

721
00:26:06,154 --> 00:26:06,654
billing.

722
00:26:07,240 --> 00:26:10,039
So go to them and say, hey. Can

723
00:26:10,039 --> 00:26:11,759
you just tell me you know, let's take

724
00:26:11,759 --> 00:26:13,079
a look at my patient list. I have

725
00:26:13,079 --> 00:26:14,919
these 10 patients that I have to see

726
00:26:14,919 --> 00:26:15,980
that are on my schedule.

727
00:26:17,399 --> 00:26:18,380
What are the rules?

728
00:26:18,839 --> 00:26:20,220
What insurance are they?

729
00:26:21,015 --> 00:26:22,474
Start there. Yep.

730
00:26:22,775 --> 00:26:25,414
Because you could potentially have 10 patients on

731
00:26:25,414 --> 00:26:27,974
your schedule. Every single one of them may

732
00:26:27,974 --> 00:26:28,955
have a different rule.

733
00:26:29,734 --> 00:26:30,234
Yep.

734
00:26:30,695 --> 00:26:31,195
Generally,

735
00:26:31,575 --> 00:26:33,674
kinda you know, this is really an overarching

736
00:26:33,974 --> 00:26:37,309
broad statement, but generally, start with Medicare. What

737
00:26:37,309 --> 00:26:40,110
does CMS say? What does CMS define it

738
00:26:40,110 --> 00:26:42,289
as? Because that's generally the basis

739
00:26:42,990 --> 00:26:44,769
of where you start. Yep.

740
00:26:45,070 --> 00:26:47,390
Then you have some nitty gritty nuances or

741
00:26:47,390 --> 00:26:50,049
restrictions put in, but that's where you start

742
00:26:51,325 --> 00:26:53,565
and kind of go from there. Yep. Awesome.

743
00:26:53,565 --> 00:26:55,724
Thank you, Lisa. Okay. Yeah. I wanna talk

744
00:26:55,724 --> 00:26:57,644
about I wanna switch gears a tiny bit.

745
00:26:57,644 --> 00:26:59,644
I wanna talk about where we are in

746
00:26:59,644 --> 00:27:01,184
this entire process

747
00:27:01,484 --> 00:27:02,784
today. So

748
00:27:03,164 --> 00:27:05,184
Lisa and I are recording this podcast

749
00:27:05,565 --> 00:27:08,259
March 5, and it is 10:38AM

750
00:27:08,259 --> 00:27:09,940
right now. I do not know when this

751
00:27:09,940 --> 00:27:11,240
is gonna hit the

752
00:27:11,859 --> 00:27:14,659
Internet. Okay? Hopefully, in the next day or

753
00:27:14,659 --> 00:27:16,099
two, I have a wonderful team that will

754
00:27:16,099 --> 00:27:18,220
get this out. So say this hits March

755
00:27:18,220 --> 00:27:19,399
6, March 7.

756
00:27:20,054 --> 00:27:22,154
The AMA open comment period

757
00:27:22,855 --> 00:27:25,115
opens March 6. So

758
00:27:25,815 --> 00:27:27,575
tell the people how they can get involved

759
00:27:27,575 --> 00:27:28,234
in that.

760
00:27:28,774 --> 00:27:29,754
Alright. So

761
00:27:30,134 --> 00:27:31,754
as Theresa said, the

762
00:27:32,859 --> 00:27:33,919
open comment period

763
00:27:34,299 --> 00:27:34,799
opens

764
00:27:35,099 --> 00:27:38,380
for us tomorrow, March 6. So what that

765
00:27:38,380 --> 00:27:41,659
also means is the public agenda for the

766
00:27:41,659 --> 00:27:43,500
meeting is going to be available March 6.

767
00:27:43,500 --> 00:27:45,599
Right now, there is no public agenda available.

768
00:27:45,924 --> 00:27:48,244
There is basically what's called a lab agenda,

769
00:27:48,244 --> 00:27:49,765
and there's not a lot of information in

770
00:27:49,765 --> 00:27:50,265
it.

771
00:27:51,525 --> 00:27:52,025
So

772
00:27:52,724 --> 00:27:54,664
what you wanna be looking at is

773
00:27:55,684 --> 00:27:58,984
get registered to be part of the AMA.

774
00:27:59,369 --> 00:28:02,190
Whether that's you are going to register and

775
00:28:02,730 --> 00:28:05,289
participate in the hybrid meeting or if you're

776
00:28:05,289 --> 00:28:05,950
in Boston,

777
00:28:06,970 --> 00:28:07,930
be there in person.

778
00:28:09,450 --> 00:28:11,230
And that is our opportunity

779
00:28:11,529 --> 00:28:12,589
to potentially

780
00:28:12,890 --> 00:28:14,109
be able to state,

781
00:28:14,474 --> 00:28:14,974
and

782
00:28:15,355 --> 00:28:16,974
this is where the

783
00:28:17,674 --> 00:28:20,015
editorial panel starts to solicit

784
00:28:20,714 --> 00:28:23,054
input from practicing clinicians,

785
00:28:23,355 --> 00:28:23,855
physicians,

786
00:28:25,674 --> 00:28:26,174
advisories

787
00:28:26,899 --> 00:28:29,059
from all of the different societies out there

788
00:28:29,059 --> 00:28:31,700
and not just speech. Like, there's a litany

789
00:28:31,700 --> 00:28:33,779
of codes that they are looking at every

790
00:28:33,779 --> 00:28:35,779
time they meet, and we're just a small

791
00:28:35,779 --> 00:28:36,759
part of that agenda.

792
00:28:37,299 --> 00:28:40,659
Registration and getting any information is mandatory whether

793
00:28:40,659 --> 00:28:42,715
you are attending in person or virtually. So

794
00:28:42,715 --> 00:28:43,215
register.

795
00:28:44,475 --> 00:28:46,815
That is my first to do. Register,

796
00:28:47,515 --> 00:28:49,755
and then if it's March 6 or after

797
00:28:49,755 --> 00:28:51,674
March 6, pull up the public agenda and

798
00:28:51,674 --> 00:28:52,975
see what's being said.

799
00:28:54,555 --> 00:28:56,555
Next kind of, like, action step you wanna

800
00:28:56,555 --> 00:28:57,055
take,

801
00:28:57,460 --> 00:28:57,960
register

802
00:28:58,500 --> 00:29:01,080
for the AMA CPT editorial

803
00:29:01,940 --> 00:29:02,440
updates.

804
00:29:03,460 --> 00:29:05,940
That way you're getting the information directly from

805
00:29:05,940 --> 00:29:06,600
the source.

806
00:29:07,940 --> 00:29:10,039
Also register for the CMS

807
00:29:10,795 --> 00:29:11,295
updates.

808
00:29:11,914 --> 00:29:13,634
They will come to your email box sometimes

809
00:29:13,835 --> 00:29:15,275
depending on what buttons you click. You might

810
00:29:15,275 --> 00:29:16,795
get one email. You might get a dozen

811
00:29:16,795 --> 00:29:19,035
a day. Depending on what setting you're in,

812
00:29:19,035 --> 00:29:21,775
you can really customize what information you want.

813
00:29:22,634 --> 00:29:24,474
But start getting the updates because I feel

814
00:29:24,474 --> 00:29:26,414
like a lot of times we're very

815
00:29:26,980 --> 00:29:30,119
reactive once information has gone through other organizations.

816
00:29:30,579 --> 00:29:32,659
But if you can get that information directly

817
00:29:32,659 --> 00:29:35,539
from the source sooner rather than later, you

818
00:29:35,539 --> 00:29:38,119
can start preparing with what you wanna do.

819
00:29:38,684 --> 00:29:39,184
Also,

820
00:29:40,605 --> 00:29:41,904
take a look at

821
00:29:42,684 --> 00:29:44,625
what some of the revision

822
00:29:45,164 --> 00:29:45,664
recommendations

823
00:29:46,125 --> 00:29:46,625
are.

824
00:29:47,005 --> 00:29:47,505
So,

825
00:29:48,525 --> 00:29:49,025
it's

826
00:29:49,565 --> 00:29:51,105
a little hard to find,

827
00:29:51,565 --> 00:29:52,384
but within

828
00:29:52,845 --> 00:29:53,345
AMA,

829
00:29:54,409 --> 00:29:56,750
there is a meeting minutes

830
00:29:58,089 --> 00:30:01,470
PDF that's from this past fall. And, basically,

831
00:30:01,529 --> 00:30:02,509
it goes through

832
00:30:02,970 --> 00:30:05,630
what the CPT revision recommendations

833
00:30:06,009 --> 00:30:07,369
are, and there's quite a few of them.

834
00:30:07,369 --> 00:30:09,845
There's some different organizations that have submitted,

835
00:30:11,505 --> 00:30:13,045
for those change code recommendations.

836
00:30:14,065 --> 00:30:15,924
So take a look at those code recommendations.

837
00:30:16,705 --> 00:30:17,205
And

838
00:30:17,585 --> 00:30:19,285
whether or not you're able to

839
00:30:19,840 --> 00:30:21,759
hop in on that AMA meeting, so the

840
00:30:21,759 --> 00:30:24,799
meeting is April 30 through May 2, we

841
00:30:24,799 --> 00:30:26,340
don't know where we are on the agenda.

842
00:30:26,880 --> 00:30:27,920
We could be first, we could be last,

843
00:30:27,920 --> 00:30:28,960
we could be somewhere in the middle. We

844
00:30:28,960 --> 00:30:30,259
just don't know at this point.

845
00:30:31,360 --> 00:30:33,700
But take a look at what's being proposed

846
00:30:35,954 --> 00:30:39,335
and really look at, okay, which hits me,

847
00:30:39,474 --> 00:30:41,234
which areas or things that I include in

848
00:30:41,234 --> 00:30:41,974
my practice,

849
00:30:42,515 --> 00:30:45,255
what are things that I am treating clinically

850
00:30:45,315 --> 00:30:45,815
now,

851
00:30:46,194 --> 00:30:48,035
and how do I define that, and how

852
00:30:48,035 --> 00:30:48,934
do I define

853
00:30:49,279 --> 00:30:51,759
kind of the time that is necessary to

854
00:30:51,759 --> 00:30:52,980
do this part of our treatment?

855
00:30:53,679 --> 00:30:54,179
Because,

856
00:30:54,559 --> 00:30:56,399
you know, we've had this catch all code

857
00:30:56,399 --> 00:30:58,960
where we've kinda just been lumping everything in,

858
00:30:58,960 --> 00:31:01,519
and maybe Monday, you're treating one thing. Tuesday,

859
00:31:01,519 --> 00:31:03,359
you're treating a different thing. Wednesday, you're treating

860
00:31:03,359 --> 00:31:03,859
another,

861
00:31:04,224 --> 00:31:05,744
but it's all under the same code. So

862
00:31:05,744 --> 00:31:07,125
we have to be able to define

863
00:31:07,744 --> 00:31:08,724
to the panel

864
00:31:09,825 --> 00:31:12,004
this is the complexity of what we're doing,

865
00:31:12,065 --> 00:31:14,004
but we also have to talk their language.

866
00:31:14,625 --> 00:31:16,384
So why is it a complex code? Why

867
00:31:16,384 --> 00:31:18,679
is clinical skill need? What diagnostics

868
00:31:19,220 --> 00:31:20,119
does this address?

869
00:31:20,659 --> 00:31:21,399
And getting

870
00:31:21,859 --> 00:31:24,919
really intentional about what your treatments look like

871
00:31:25,139 --> 00:31:26,599
and start writing them down.

872
00:31:27,380 --> 00:31:29,079
So if you are called

873
00:31:29,619 --> 00:31:30,440
to speak

874
00:31:31,335 --> 00:31:33,515
during the meeting, you have talking point.

875
00:31:35,174 --> 00:31:37,355
Another kind of action thing I would say

876
00:31:37,575 --> 00:31:38,075
is

877
00:31:38,615 --> 00:31:40,474
if you're not involved at your state level,

878
00:31:41,654 --> 00:31:43,494
get involved at your state level. We should

879
00:31:43,494 --> 00:31:45,434
be making phone calls to our state organization,

880
00:31:45,654 --> 00:31:47,259
shooting them emails. However

881
00:31:47,640 --> 00:31:49,799
form of communication you have with your state

882
00:31:49,799 --> 00:31:50,299
organization

883
00:31:50,759 --> 00:31:54,119
because those larger bodies that represent a larger

884
00:31:54,119 --> 00:31:56,279
group of us, they have a louder voice

885
00:31:56,279 --> 00:31:59,160
in these meetings. They are generally recognized before

886
00:31:59,160 --> 00:32:00,460
an individual is.

887
00:32:00,964 --> 00:32:02,884
So if we can get our voice out

888
00:32:02,884 --> 00:32:03,945
to those organizations,

889
00:32:04,964 --> 00:32:07,605
we have a better chance of what we

890
00:32:07,605 --> 00:32:08,664
want being heard.

891
00:32:10,325 --> 00:32:11,924
So that's kind of the the what do

892
00:32:11,924 --> 00:32:13,704
we do immediately right now.

893
00:32:14,724 --> 00:32:14,884
I

894
00:32:15,599 --> 00:32:17,119
you know, I'm someone who I'm like, you

895
00:32:17,119 --> 00:32:18,640
know what? This information has been out there

896
00:32:18,640 --> 00:32:20,819
for a while. We've known since this summer

897
00:32:21,359 --> 00:32:23,919
when they put in the editorial recommendations for

898
00:32:23,919 --> 00:32:26,000
the September meeting. Like, this has been a

899
00:32:26,000 --> 00:32:26,980
long time coming.

900
00:32:27,934 --> 00:32:30,095
And now it's what do we do? How

901
00:32:30,095 --> 00:32:31,795
do we prepare? How do we

902
00:32:33,375 --> 00:32:34,115
make ourselves

903
00:32:34,414 --> 00:32:36,575
have less of a risk when and if

904
00:32:36,575 --> 00:32:37,714
changes are made?

905
00:32:38,174 --> 00:32:40,335
Because we don't know. And what we've seen

906
00:32:40,335 --> 00:32:41,480
is while,

907
00:32:41,859 --> 00:32:44,440
yes, there's this January 1 date looming,

908
00:32:45,220 --> 00:32:48,039
we've seen historically where AMA makes a recommendation

909
00:32:48,179 --> 00:32:50,039
and CMS is like, yeah. No.

910
00:32:50,819 --> 00:32:52,980
Go back to the drawing board. That might

911
00:32:52,980 --> 00:32:53,480
happen.

912
00:32:53,914 --> 00:32:56,174
So we wanna make sure that our voices

913
00:32:56,315 --> 00:32:56,815
and

914
00:32:57,194 --> 00:32:58,815
the skill that this code

915
00:32:59,515 --> 00:33:01,835
encompasses and even all of the breakdowns that

916
00:33:01,835 --> 00:33:04,255
are recommended in some of those revisions,

917
00:33:05,194 --> 00:33:07,240
that we're able to talk about them. And

918
00:33:07,240 --> 00:33:08,679
we're able to say, you know, as a

919
00:33:08,679 --> 00:33:10,839
pediatric clinician, I do x y z, and

920
00:33:10,839 --> 00:33:13,559
here's the skill involved. Here's the time involved.

921
00:33:13,559 --> 00:33:16,279
Here's the complexity of the diagnoses that I'm

922
00:33:16,279 --> 00:33:17,019
looking at

923
00:33:17,480 --> 00:33:18,779
versus as

924
00:33:19,095 --> 00:33:19,595
a

925
00:33:19,974 --> 00:33:22,054
SLP who's in a geriatric setting. These are

926
00:33:22,054 --> 00:33:24,794
the diagnostics I treat. These are the complexities.

927
00:33:24,934 --> 00:33:27,095
This is the time that I spend on

928
00:33:27,095 --> 00:33:27,835
these codes

929
00:33:28,134 --> 00:33:30,154
and why it's so vastly different.

930
00:33:30,934 --> 00:33:33,174
I think that's really important because it is

931
00:33:33,174 --> 00:33:34,394
shocking when you realize,

932
00:33:34,740 --> 00:33:36,420
oh my gosh. We're all using the same

933
00:33:36,420 --> 00:33:36,920
code.

934
00:33:38,500 --> 00:33:39,720
And should we be?

935
00:33:40,259 --> 00:33:42,420
Right. No. I I don't think so. You

936
00:33:42,420 --> 00:33:43,859
know? I I mean and I think that's

937
00:33:43,859 --> 00:33:45,559
just the tough part right now. It's like,

938
00:33:45,859 --> 00:33:47,700
we've all been saying this that we all

939
00:33:47,700 --> 00:33:49,904
treat just such a wide variety of things,

940
00:33:49,904 --> 00:33:51,605
and why are we all getting reimbursed

941
00:33:52,384 --> 00:33:54,704
the same? And and, you know, it's like

942
00:33:54,704 --> 00:33:56,944
we've been arguing for this. And now that

943
00:33:56,944 --> 00:33:57,605
it's here,

944
00:33:57,904 --> 00:34:00,144
we are freaking out about it. You know?

945
00:34:00,144 --> 00:34:02,259
And there's, you know, it's, yeah, there's some

946
00:34:02,259 --> 00:34:04,180
things that have been proposed that are not

947
00:34:04,180 --> 00:34:06,180
okay, and that's why we use our voices

948
00:34:06,180 --> 00:34:08,099
to to go ahead and speak up. So

949
00:34:08,340 --> 00:34:10,280
okay. So that you explained the AMA,

950
00:34:10,579 --> 00:34:11,239
the CPT,

951
00:34:12,500 --> 00:34:15,300
and then my understanding also is that towards

952
00:34:15,605 --> 00:34:17,045
is it the end of the summer when

953
00:34:17,045 --> 00:34:18,804
they actually look at the values? Is that

954
00:34:18,804 --> 00:34:19,304
right?

955
00:34:20,005 --> 00:34:22,404
Yep. So once things go that through the

956
00:34:22,404 --> 00:34:25,364
CPT o CPT editorial panel, once there's a

957
00:34:25,364 --> 00:34:27,364
chance for kind of all of the collective

958
00:34:27,364 --> 00:34:29,144
voices to be heard more or less,

959
00:34:30,320 --> 00:34:30,820
Then

960
00:34:31,519 --> 00:34:33,599
what comes out in the summer is the

961
00:34:33,599 --> 00:34:34,659
AMA's recommendation.

962
00:34:35,280 --> 00:34:35,780
So

963
00:34:36,079 --> 00:34:36,900
mid summer,

964
00:34:37,440 --> 00:34:39,280
I wanna say July is generally when it

965
00:34:39,280 --> 00:34:40,099
comes out.

966
00:34:40,800 --> 00:34:43,034
There's not a set date, but it's generally

967
00:34:43,094 --> 00:34:45,594
July is when they put out the recommendation.

968
00:34:47,255 --> 00:34:50,054
After that, there's another comment period, and then

969
00:34:50,054 --> 00:34:52,155
that's when CMS reviews as well.

970
00:34:52,934 --> 00:34:53,574
So we'll

971
00:34:54,389 --> 00:34:56,150
depending on what they say, we know that

972
00:34:56,150 --> 00:34:58,650
things have been recommended. We have

973
00:34:58,949 --> 00:35:00,089
a set of codes.

974
00:35:01,029 --> 00:35:01,529
So

975
00:35:01,909 --> 00:35:03,909
I think it's 92X0X

976
00:35:03,909 --> 00:35:05,690
through 92X9X

977
00:35:05,750 --> 00:35:06,730
have been proposed.

978
00:35:08,905 --> 00:35:11,304
Chances are that's what's gonna go through. Maybe

979
00:35:11,304 --> 00:35:13,464
there'll be a few revisions, maybe an addition

980
00:35:13,464 --> 00:35:14,364
here or there,

981
00:35:14,744 --> 00:35:17,464
but highly likely that those codes in some

982
00:35:17,464 --> 00:35:19,244
form or another are going to move forward.

983
00:35:20,130 --> 00:35:20,630
So

984
00:35:21,409 --> 00:35:23,809
be looking for what that code structure looks

985
00:35:23,809 --> 00:35:26,369
like and those open comment periods. Like I

986
00:35:26,369 --> 00:35:27,829
said, make sure you're registered

987
00:35:28,130 --> 00:35:31,029
for those CMS updates, for those AMA updates.

988
00:35:31,409 --> 00:35:33,329
That way you can get ahead of it

989
00:35:33,329 --> 00:35:34,954
because there's a lot of

990
00:35:35,335 --> 00:35:37,675
confidentiality that goes into these closed door meetings.

991
00:35:38,295 --> 00:35:38,795
And

992
00:35:39,815 --> 00:35:42,375
if you're not aware of when publications are

993
00:35:42,375 --> 00:35:44,055
coming out and you're reading them, you might

994
00:35:44,055 --> 00:35:45,434
miss those comment periods.

995
00:35:46,070 --> 00:35:48,949
And there's also a very limited number of

996
00:35:48,949 --> 00:35:51,190
individuals that can comment on these as well,

997
00:35:51,190 --> 00:35:52,949
which is why it's so important, you know,

998
00:35:52,949 --> 00:35:55,349
even after this April 30 meeting,

999
00:35:56,150 --> 00:35:56,650
closes,

1000
00:35:58,164 --> 00:36:00,264
we wanna continue to have our voices heard.

1001
00:36:00,404 --> 00:36:00,904
So

1002
00:36:01,525 --> 00:36:04,244
getting in front of our national organizations, getting

1003
00:36:04,244 --> 00:36:06,664
in front of our state organizations, talking to

1004
00:36:06,804 --> 00:36:09,384
our physician groups, is this gonna impact them?

1005
00:36:10,670 --> 00:36:12,030
You know, if you're somebody who's in a

1006
00:36:12,030 --> 00:36:14,289
high managed care state, start asking those questions.

1007
00:36:14,430 --> 00:36:16,670
What are they doing? Your state boards, your

1008
00:36:16,670 --> 00:36:19,150
Medicaid boards, we've seen changes already on the

1009
00:36:19,150 --> 00:36:21,390
Medicaid side in some of the states that

1010
00:36:21,390 --> 00:36:23,950
I'm in where we already have coding that

1011
00:36:23,950 --> 00:36:26,289
is different and restrictions within our codes.

1012
00:36:26,594 --> 00:36:28,434
Making sure that you're aware of when those

1013
00:36:28,434 --> 00:36:31,175
changes happen and when the comment periods open

1014
00:36:31,394 --> 00:36:33,875
and being prepared to make a statement, make

1015
00:36:33,875 --> 00:36:34,534
a comment.

1016
00:36:35,394 --> 00:36:37,234
And while it's great, you know, social media

1017
00:36:37,234 --> 00:36:39,155
is a great way to get information out

1018
00:36:39,155 --> 00:36:40,775
very quickly to hit a wide

1019
00:36:41,109 --> 00:36:42,969
breadth of individuals and audience,

1020
00:36:44,309 --> 00:36:46,150
sometimes that's not where the action has to

1021
00:36:46,150 --> 00:36:46,650
happen.

1022
00:36:46,949 --> 00:36:48,309
It has to happen in front of these

1023
00:36:48,309 --> 00:36:50,809
panels. It has to happen through these

1024
00:36:51,750 --> 00:36:52,250
logistics

1025
00:36:53,030 --> 00:36:54,550
and through a lot of these closed door

1026
00:36:54,550 --> 00:36:55,050
communities.

1027
00:36:56,264 --> 00:36:57,944
So trying to get our voice in there

1028
00:36:57,944 --> 00:36:59,164
is is really important.

1029
00:36:59,545 --> 00:37:01,144
Yeah. Lisa, talk to me about because I

1030
00:37:01,144 --> 00:37:03,704
know there is this NDA involved with the

1031
00:37:03,704 --> 00:37:05,885
AMA, and I've heard so many different

1032
00:37:06,905 --> 00:37:10,139
crazy things that you can't even comment or

1033
00:37:10,139 --> 00:37:12,380
anything unless you sign this NDA. If you

1034
00:37:12,380 --> 00:37:15,039
sign this NDA, you can't speak about anything.

1035
00:37:15,739 --> 00:37:17,739
Share what you know. So within the AMA

1036
00:37:17,739 --> 00:37:19,199
process and they have different,

1037
00:37:20,219 --> 00:37:22,380
depending on where you're making comments and where

1038
00:37:22,380 --> 00:37:23,359
you're making suggestions.

1039
00:37:24,005 --> 00:37:25,625
Depends on the type of confidentiality,

1040
00:37:26,485 --> 00:37:28,485
statements, and agreements, and NDAs that have to

1041
00:37:28,485 --> 00:37:29,144
be signed.

1042
00:37:29,445 --> 00:37:30,664
So, essentially,

1043
00:37:31,364 --> 00:37:32,744
what it means is

1044
00:37:33,125 --> 00:37:34,965
if and while you are part of the

1045
00:37:34,965 --> 00:37:36,505
process. So, for example,

1046
00:37:38,780 --> 00:37:39,280
when

1047
00:37:40,780 --> 00:37:42,800
the cognitive codes were being reviewed,

1048
00:37:43,420 --> 00:37:44,860
kind of that 2018

1049
00:37:44,860 --> 00:37:46,480
to 2020 time frame,

1050
00:37:47,579 --> 00:37:51,039
there were board members presented on the

1051
00:37:51,575 --> 00:37:53,735
CPT editorial panel and then also on the

1052
00:37:53,735 --> 00:37:56,215
rock panel and individuals that were invited to

1053
00:37:56,215 --> 00:37:58,235
speak in those closed door meetings.

1054
00:37:59,335 --> 00:38:02,394
Until AMA came forward and published information,

1055
00:38:03,175 --> 00:38:05,994
either via through their meeting agenda notes,

1056
00:38:06,535 --> 00:38:08,880
through their public comment policy, or through their

1057
00:38:08,880 --> 00:38:09,780
general publications.

1058
00:38:10,319 --> 00:38:12,480
Individuals who are invited into those meetings could

1059
00:38:12,480 --> 00:38:14,019
not speak about them

1060
00:38:15,280 --> 00:38:15,780
without

1061
00:38:16,559 --> 00:38:18,420
legal repercussions happening.

1062
00:38:18,719 --> 00:38:20,420
It's one of those things where

1063
00:38:21,375 --> 00:38:23,934
if you're invited to speak in these committee

1064
00:38:23,934 --> 00:38:24,434
meetings,

1065
00:38:25,695 --> 00:38:27,454
you wanna get as much information as you

1066
00:38:27,454 --> 00:38:29,135
can, but also knowing that you can't speak

1067
00:38:29,135 --> 00:38:31,715
about it until somebody else says go.

1068
00:38:32,015 --> 00:38:32,515
Yeah.

1069
00:38:34,109 --> 00:38:36,190
Which we could look at as a positive

1070
00:38:36,190 --> 00:38:38,769
or a negative, but there's a process involved.

1071
00:38:39,309 --> 00:38:41,150
And part of the process is getting all

1072
00:38:41,150 --> 00:38:43,469
of those voices, making sure they're going through

1073
00:38:43,469 --> 00:38:44,449
the correct channels,

1074
00:38:45,724 --> 00:38:46,704
and speaking

1075
00:38:47,164 --> 00:38:49,724
when the option is available and being ready

1076
00:38:49,724 --> 00:38:52,364
to present as much information in a short

1077
00:38:52,364 --> 00:38:53,744
time frame as possible.

1078
00:38:54,045 --> 00:38:54,785
But, also,

1079
00:38:55,405 --> 00:38:56,224
it's frustrating

1080
00:38:56,525 --> 00:38:57,025
for

1081
00:38:57,565 --> 00:38:59,485
the frontline SLP to be like, how come

1082
00:38:59,485 --> 00:39:02,099
we didn't hear about this? Right. Well, we've

1083
00:39:02,099 --> 00:39:03,859
been hearing about it. We just haven't been

1084
00:39:03,859 --> 00:39:06,119
getting all the nitty gritty detail because

1085
00:39:06,900 --> 00:39:07,880
it's not published.

1086
00:39:08,339 --> 00:39:08,839
Yeah.

1087
00:39:09,139 --> 00:39:11,619
Yeah. So being prepared to react when the

1088
00:39:11,619 --> 00:39:13,559
information is presented to us

1089
00:39:14,034 --> 00:39:16,695
and also knowing what does reaction look like.

1090
00:39:17,074 --> 00:39:18,375
Is reaction advocacy

1091
00:39:19,155 --> 00:39:20,054
or is reaction

1092
00:39:20,675 --> 00:39:21,175
complaining

1093
00:39:21,795 --> 00:39:23,954
and saying, oh my gosh. What do I

1094
00:39:23,954 --> 00:39:26,550
do? Everything is a disaster, and it's not.

1095
00:39:26,630 --> 00:39:28,390
This is just part of the process as

1096
00:39:28,390 --> 00:39:30,869
an opportunity for us. Like you said, we've

1097
00:39:30,869 --> 00:39:32,809
been asking for this for a long time.

1098
00:39:32,949 --> 00:39:34,010
Yeah. Whether we

1099
00:39:34,309 --> 00:39:35,769
knew what that ask meant

1100
00:39:36,070 --> 00:39:38,469
Yep. Or not. We've been asking for a

1101
00:39:38,469 --> 00:39:40,815
long time. We've been trying to compare ourselves

1102
00:39:40,875 --> 00:39:43,594
in some areas to PT and OT, and

1103
00:39:43,594 --> 00:39:46,074
we're very different than PT and OT. Our

1104
00:39:46,074 --> 00:39:48,875
coding structure has been very different, but we've

1105
00:39:48,875 --> 00:39:50,414
been seeing this collective

1106
00:39:50,795 --> 00:39:51,934
shift throughout

1107
00:39:53,170 --> 00:39:54,230
reimbursement structuring

1108
00:39:54,530 --> 00:39:57,030
throughout the medical sector of trying to align

1109
00:39:57,090 --> 00:39:58,230
as much as possible

1110
00:39:59,250 --> 00:40:01,510
so we have kind of this systematic

1111
00:40:01,890 --> 00:40:02,390
consistency.

1112
00:40:03,010 --> 00:40:03,510
Yep.

1113
00:40:04,289 --> 00:40:06,309
And that's what we're moving towards.

1114
00:40:06,714 --> 00:40:08,954
That's what we should have been preparing for

1115
00:40:08,954 --> 00:40:10,175
for a long time. And,

1116
00:40:11,755 --> 00:40:12,255
unfortunately,

1117
00:40:12,554 --> 00:40:14,714
like you said, we don't get this information

1118
00:40:14,714 --> 00:40:16,714
in grad school. We get a trial by

1119
00:40:16,714 --> 00:40:17,214
fire,

1120
00:40:17,994 --> 00:40:20,554
and, generally, it's not until you either had

1121
00:40:20,554 --> 00:40:23,119
a denial thrown in your lap or you

1122
00:40:23,119 --> 00:40:25,199
attempt to pivot or maybe you go into

1123
00:40:25,199 --> 00:40:27,360
a different position that you start asking those

1124
00:40:27,360 --> 00:40:27,860
questions.

1125
00:40:28,160 --> 00:40:29,680
Yeah. Thank you. I think, you know, and

1126
00:40:29,680 --> 00:40:32,180
the complexity comes into play here too with

1127
00:40:32,640 --> 00:40:34,880
comparing ourselves to PT because there's a lot

1128
00:40:34,880 --> 00:40:36,764
of aspects of what we do that is

1129
00:40:37,164 --> 00:40:39,025
super, super similar. We diagnose.

1130
00:40:39,484 --> 00:40:41,264
We do treatments. We do exercises.

1131
00:40:41,724 --> 00:40:44,704
We help to improve muscle strength and coordination

1132
00:40:44,844 --> 00:40:45,505
and then,

1133
00:40:45,885 --> 00:40:48,224
you know, do some more updated testing and

1134
00:40:48,364 --> 00:40:50,204
then they graduate. You know? And that's very

1135
00:40:50,204 --> 00:40:52,409
much like PT. There's other parts of what

1136
00:40:52,409 --> 00:40:54,170
we do, like, I think about, you know,

1137
00:40:54,170 --> 00:40:56,570
trach management in the ICU. You know? That

1138
00:40:56,570 --> 00:40:58,889
is so far off and is, you know,

1139
00:40:58,889 --> 00:40:59,710
not considered,

1140
00:41:00,170 --> 00:41:01,949
you know, an exercise based

1141
00:41:02,250 --> 00:41:04,170
therapy that, you know, there's just so much

1142
00:41:04,170 --> 00:41:06,284
complexity. Right? So it's like, don't come for

1143
00:41:06,284 --> 00:41:08,684
me guys when I make these generalizations online

1144
00:41:08,684 --> 00:41:09,184
that

1145
00:41:09,565 --> 00:41:11,324
because I'm just trying to get us to

1146
00:41:11,324 --> 00:41:11,824
understand

1147
00:41:12,605 --> 00:41:14,525
why we need to all be speaking up

1148
00:41:14,525 --> 00:41:17,425
for our own lived experiences, patient populations,

1149
00:41:18,059 --> 00:41:19,820
settings that we work in because they are

1150
00:41:19,820 --> 00:41:22,059
just so vastly different. And to just say

1151
00:41:22,059 --> 00:41:23,739
that this one blanket code that we've all

1152
00:41:23,739 --> 00:41:25,579
been billing for fifteen years is the way

1153
00:41:25,579 --> 00:41:26,780
to go, we all know that's not the

1154
00:41:26,780 --> 00:41:27,760
way to go. So

1155
00:41:28,140 --> 00:41:29,864
this this is the time for us to

1156
00:41:29,864 --> 00:41:31,945
speak up as much as we can, and,

1157
00:41:31,945 --> 00:41:33,465
you know, I don't know what I don't

1158
00:41:33,465 --> 00:41:35,565
know. Lisa doesn't know what she doesn't know.

1159
00:41:35,625 --> 00:41:37,224
The only way that these people are gonna

1160
00:41:37,224 --> 00:41:39,144
change the system is if they hear from

1161
00:41:39,144 --> 00:41:41,784
you. So it's just really important to me

1162
00:41:41,784 --> 00:41:42,605
that people

1163
00:41:43,320 --> 00:41:45,500
channel their anger and their frustration

1164
00:41:45,800 --> 00:41:46,780
in the right

1165
00:41:47,160 --> 00:41:50,119
manner because just, you know, spreading this panic,

1166
00:41:50,119 --> 00:41:52,280
fear, doom, and gloom is not productive for

1167
00:41:52,280 --> 00:41:54,280
anybody. You know? If if you all of

1168
00:41:54,280 --> 00:41:56,119
a sudden close-up your private practice, you're not

1169
00:41:56,119 --> 00:41:58,394
helping anybody. Right? So we've

1170
00:41:58,695 --> 00:42:00,315
we've gotta get some

1171
00:42:01,015 --> 00:42:03,755
knowledge around this to be able to advocate

1172
00:42:04,055 --> 00:42:04,555
appropriately.

1173
00:42:05,335 --> 00:42:06,775
And I think and that's the the big

1174
00:42:06,775 --> 00:42:08,375
thing too is we can't just write in

1175
00:42:08,375 --> 00:42:10,454
and say, you know, this isn't fair. This

1176
00:42:10,454 --> 00:42:12,535
isn't our field is so much more complex.

1177
00:42:12,535 --> 00:42:15,469
You have to give patient specific examples of

1178
00:42:15,469 --> 00:42:17,789
your lived experiences and your patient settings and

1179
00:42:17,789 --> 00:42:18,769
your patient populations.

1180
00:42:19,469 --> 00:42:21,710
Yeah. And I think, you know, I think

1181
00:42:21,710 --> 00:42:23,550
when you ask, okay. What do I do

1182
00:42:23,550 --> 00:42:24,690
as, you know,

1183
00:42:25,805 --> 00:42:26,704
Susie SLP

1184
00:42:27,005 --> 00:42:30,525
on Lonely SLP Island out here in rural

1185
00:42:30,525 --> 00:42:31,025
Nebraska?

1186
00:42:31,565 --> 00:42:33,644
What can I do about it? So we've

1187
00:42:33,644 --> 00:42:35,825
talked about some tangible steps, like, within

1188
00:42:36,204 --> 00:42:37,825
kind of this revision process.

1189
00:42:39,410 --> 00:42:40,470
But let's say

1190
00:42:41,170 --> 00:42:42,550
the revisions go through,

1191
00:42:42,849 --> 00:42:45,250
you know, we're given whatever relative value we're

1192
00:42:45,250 --> 00:42:45,750
given.

1193
00:42:47,570 --> 00:42:49,410
What does that mean for you, for your

1194
00:42:49,410 --> 00:42:50,789
practice, for your business,

1195
00:42:51,170 --> 00:42:52,710
for where you're structured,

1196
00:42:53,214 --> 00:42:54,494
and are there things that you can do

1197
00:42:54,494 --> 00:42:55,315
about it now?

1198
00:42:55,614 --> 00:42:57,234
Yeah. We can prepare.

1199
00:42:57,694 --> 00:43:00,194
Knowing what we know, knowing the

1200
00:43:00,655 --> 00:43:01,155
potential

1201
00:43:01,534 --> 00:43:02,755
of what might happen.

1202
00:43:03,054 --> 00:43:05,554
You know, we don't know the exact numerics.

1203
00:43:05,694 --> 00:43:07,614
We don't know the exact value that's gonna

1204
00:43:07,614 --> 00:43:09,550
come forth yet. We don't know exactly

1205
00:43:09,849 --> 00:43:12,969
what MUE edits and NCCI edits are gonna

1206
00:43:12,969 --> 00:43:13,469
happen,

1207
00:43:14,170 --> 00:43:16,030
but we know something's going to happen.

1208
00:43:16,570 --> 00:43:19,050
So how do we kind of protect our

1209
00:43:19,050 --> 00:43:19,550
practices,

1210
00:43:19,929 --> 00:43:21,150
protect our profession,

1211
00:43:21,965 --> 00:43:24,525
and what are some tangible things that we

1212
00:43:24,525 --> 00:43:25,184
can do

1213
00:43:25,565 --> 00:43:26,784
individually and operationally?

1214
00:43:27,164 --> 00:43:28,605
Because there's a lot of things that we

1215
00:43:28,605 --> 00:43:29,985
can do. And

1216
00:43:30,445 --> 00:43:32,204
there's kind of you know, we talked about

1217
00:43:32,204 --> 00:43:32,684
this,

1218
00:43:33,644 --> 00:43:35,644
kind of on an organizational level. Like, what

1219
00:43:35,644 --> 00:43:36,625
are some of these

1220
00:43:37,170 --> 00:43:39,429
shifts that we're going to potentially see?

1221
00:43:40,130 --> 00:43:41,809
So kind of, like, one of the major

1222
00:43:41,809 --> 00:43:44,050
shifts is our therapy is no longer gonna

1223
00:43:44,050 --> 00:43:44,869
be a container.

1224
00:43:45,170 --> 00:43:46,769
That is a potential shift that's going to

1225
00:43:46,769 --> 00:43:48,949
happen. We're going to have to get

1226
00:43:49,844 --> 00:43:52,244
very clear about what we are treating and

1227
00:43:52,244 --> 00:43:53,304
what we are documenting.

1228
00:43:53,605 --> 00:43:55,525
What is the domain we're looking at? What

1229
00:43:55,525 --> 00:43:56,344
is the specificity

1230
00:43:56,724 --> 00:43:59,125
of what we're treating? So getting very clear

1231
00:43:59,125 --> 00:43:59,684
and granule

1232
00:44:00,565 --> 00:44:02,644
granular on that and starting to document that

1233
00:44:02,644 --> 00:44:05,039
way. Because if we start documenting that way,

1234
00:44:05,039 --> 00:44:08,000
we're, you know, we're helping protect us ourselves

1235
00:44:08,000 --> 00:44:10,019
from audits because we know those are coming.

1236
00:44:10,480 --> 00:44:12,880
But, also, we're getting ourselves prepared for if

1237
00:44:12,880 --> 00:44:14,180
and when a shift happens.

1238
00:44:15,360 --> 00:44:18,014
Looking at time, time is gonna matter more.

1239
00:44:18,414 --> 00:44:21,054
With the proposed codes that are in there

1240
00:44:21,054 --> 00:44:22,734
right now, it's a thirty minute and fifteen

1241
00:44:22,734 --> 00:44:24,894
minute code structure essentially with those add on

1242
00:44:24,894 --> 00:44:25,394
codes.

1243
00:44:25,694 --> 00:44:27,234
Very similar to

1244
00:44:27,694 --> 00:44:29,135
the 97129,

1245
00:44:29,135 --> 00:44:31,135
nine seven one three zero cognitive codes that

1246
00:44:31,135 --> 00:44:33,154
are in in kind of our our playbook

1247
00:44:33,214 --> 00:44:33,900
right now.

1248
00:44:35,260 --> 00:44:37,440
Those differ from the eight minute rule codes.

1249
00:44:37,739 --> 00:44:40,059
So, essentially, it's a minimum of sixteen minutes

1250
00:44:40,059 --> 00:44:41,739
in order to build that first code. Then

1251
00:44:41,739 --> 00:44:43,339
once you hit over the 30, you can

1252
00:44:43,339 --> 00:44:46,079
add on to that additional code into it.

1253
00:44:46,644 --> 00:44:48,565
So look at your time. What are your

1254
00:44:48,565 --> 00:44:50,025
sessions look like time based?

1255
00:44:50,644 --> 00:44:51,465
Knowing that

1256
00:44:51,925 --> 00:44:54,345
domain specificity is gonna matter more.

1257
00:44:54,724 --> 00:44:57,305
So are we clearly defined? Am I treating

1258
00:44:57,365 --> 00:44:58,744
voice? Am I treating

1259
00:44:59,380 --> 00:45:01,400
speech language? Am I treating

1260
00:45:01,699 --> 00:45:02,199
articulation?

1261
00:45:02,659 --> 00:45:04,980
What what am I treating? And documenting it

1262
00:45:04,980 --> 00:45:05,639
as such.

1263
00:45:06,659 --> 00:45:08,579
Making sure that if you do have that

1264
00:45:08,579 --> 00:45:09,880
overlap with cognition,

1265
00:45:10,420 --> 00:45:12,420
it needs to be very, very defensible. We

1266
00:45:12,420 --> 00:45:14,359
already have cognitive codes in place.

1267
00:45:14,684 --> 00:45:17,265
Are you using those appropriately right now?

1268
00:45:17,724 --> 00:45:19,265
So take a look at your documentation.

1269
00:45:19,565 --> 00:45:21,425
Take a look at those

1270
00:45:21,965 --> 00:45:24,785
three codes essentially. Are you using them appropriately

1271
00:45:24,925 --> 00:45:27,585
right now? Do you know your rules associated

1272
00:45:27,644 --> 00:45:28,545
with those codes?

1273
00:45:29,300 --> 00:45:31,079
And then making sure your documentation

1274
00:45:31,539 --> 00:45:33,719
and this is just a good general rule.

1275
00:45:33,859 --> 00:45:36,359
Does your documentation align with the diagnosis

1276
00:45:36,659 --> 00:45:37,320
you're treating?

1277
00:45:38,420 --> 00:45:41,219
I'm getting very, very clear. We're really moving

1278
00:45:41,219 --> 00:45:42,359
from this flexibility

1279
00:45:43,105 --> 00:45:45,525
within this giant code to precision.

1280
00:45:46,945 --> 00:45:49,105
And that's what we're gonna continue to see

1281
00:45:49,105 --> 00:45:50,324
mimic kind of throughout

1282
00:45:50,625 --> 00:45:51,285
the professions.

1283
00:45:53,344 --> 00:45:55,344
And we need to be really good about

1284
00:45:55,344 --> 00:45:57,505
getting very precise about what our coding is

1285
00:45:57,505 --> 00:46:00,349
and what we're treating. Yep. Awesome. Thank you.

1286
00:46:00,569 --> 00:46:02,170
And I do wanna share too, you guys.

1287
00:46:02,170 --> 00:46:04,170
I mean, this stuff is so as Lisa

1288
00:46:04,170 --> 00:46:05,849
explained, like, if you're not getting the updates

1289
00:46:05,849 --> 00:46:07,849
right from the source, this stuff is so

1290
00:46:07,849 --> 00:46:11,130
fluid right now. Things are moving quickly. Things

1291
00:46:11,130 --> 00:46:13,304
are changing quickly. There was even something that

1292
00:46:13,304 --> 00:46:15,244
I had written a few days ago that

1293
00:46:15,465 --> 00:46:17,545
was changed this morning, and so I had

1294
00:46:17,545 --> 00:46:19,405
to edit a post before it went up.

1295
00:46:19,625 --> 00:46:21,644
There's been a lot of documentation

1296
00:46:22,025 --> 00:46:23,579
that ASHA has pulled down in the last

1297
00:46:23,660 --> 00:46:25,420
few days. I'm not gonna speculate why they

1298
00:46:25,420 --> 00:46:27,599
did that, but my guess is that something's

1299
00:46:27,660 --> 00:46:28,160
changed

1300
00:46:28,539 --> 00:46:30,219
that they heard was coming down the pike

1301
00:46:30,219 --> 00:46:32,700
or that something was changed. So I I'm

1302
00:46:32,700 --> 00:46:34,619
asking for a little grace too and that

1303
00:46:34,619 --> 00:46:37,484
I'm trying to update everybody as quick as

1304
00:46:37,484 --> 00:46:39,164
I know with the information that I have

1305
00:46:39,164 --> 00:46:40,684
in my hand at the moment that I'm

1306
00:46:40,684 --> 00:46:41,505
presenting it.

1307
00:46:41,804 --> 00:46:43,244
But if you see a post a week

1308
00:46:43,244 --> 00:46:46,144
later, like, have some grace and and

1309
00:46:47,005 --> 00:46:49,164
know that this stuff is just so fluid.

1310
00:46:49,164 --> 00:46:51,324
And please dig into it. Please ask. I'm

1311
00:46:51,324 --> 00:46:53,369
not afraid to say if I, you know,

1312
00:46:53,369 --> 00:46:55,289
missed something or if something had changed in

1313
00:46:55,289 --> 00:46:57,449
the last few days. But plea you know,

1314
00:46:57,449 --> 00:46:59,210
do your own digging, do your own research.

1315
00:46:59,210 --> 00:47:01,609
But all I can really just say is

1316
00:47:01,609 --> 00:47:04,889
is please send in your comments about your

1317
00:47:04,889 --> 00:47:05,389
specific

1318
00:47:06,065 --> 00:47:08,385
situation and your own lived experiences because we

1319
00:47:08,385 --> 00:47:10,305
all know they are so vastly different. And

1320
00:47:10,305 --> 00:47:11,925
my comment may not touch

1321
00:47:12,465 --> 00:47:14,144
an ounce of what you do in your

1322
00:47:14,144 --> 00:47:16,485
setting. You know, somebody else's comment may be

1323
00:47:16,704 --> 00:47:18,545
totally different from what you do, and and

1324
00:47:18,545 --> 00:47:20,385
that is why this is all so important

1325
00:47:20,385 --> 00:47:21,525
that we all do

1326
00:47:21,849 --> 00:47:23,769
speak up and get our voices heard because

1327
00:47:23,769 --> 00:47:25,130
it is so different. And and I'm just

1328
00:47:25,289 --> 00:47:26,569
like I said, I said at the beginning

1329
00:47:26,569 --> 00:47:28,010
of this, and I'll I'll close out with

1330
00:47:28,010 --> 00:47:30,409
it too. I'm excited about this because we've

1331
00:47:30,409 --> 00:47:31,710
been asking for this.

1332
00:47:32,409 --> 00:47:34,184
The table is available for us to pull

1333
00:47:34,184 --> 00:47:35,945
up a seat and sit at and share

1334
00:47:35,945 --> 00:47:38,105
what we want to share. So let's do

1335
00:47:38,105 --> 00:47:40,985
that. Let's not cripple ourselves with fear, but

1336
00:47:40,985 --> 00:47:43,724
let's let's get together and speak up. And

1337
00:47:44,025 --> 00:47:46,905
and I'm I'm just hopeful that this is

1338
00:47:46,905 --> 00:47:48,445
what we've been asking for.

1339
00:47:48,909 --> 00:47:50,349
Yeah. And I think, you know, like you

1340
00:47:50,349 --> 00:47:53,010
said, there's a huge opportunity for us here.

1341
00:47:53,150 --> 00:47:55,250
And coming from a place of

1342
00:47:55,949 --> 00:47:57,170
knowledge and understanding,

1343
00:47:57,469 --> 00:47:59,949
knowing that everything is fluid, we don't have

1344
00:47:59,949 --> 00:48:02,110
concrete, but there are concrete things you can

1345
00:48:02,110 --> 00:48:02,610
do.

1346
00:48:02,994 --> 00:48:05,394
You can get involved. You can advocate. You

1347
00:48:05,394 --> 00:48:08,195
can audit proof your business and prepare for

1348
00:48:08,195 --> 00:48:10,835
those what if things. And it no matter

1349
00:48:10,835 --> 00:48:12,914
what the decision is in the end, doing

1350
00:48:12,914 --> 00:48:14,755
those steps is only gonna make your practice

1351
00:48:14,755 --> 00:48:17,335
stronger. It's only gonna make our profession stronger,

1352
00:48:17,550 --> 00:48:19,710
and it's only going to make us be

1353
00:48:19,710 --> 00:48:21,489
able to speak about these things

1354
00:48:22,110 --> 00:48:22,849
more proficiently

1355
00:48:23,309 --> 00:48:24,750
moving forward. Yep.

1356
00:48:25,150 --> 00:48:25,650
So

1357
00:48:26,110 --> 00:48:28,849
get involved. And and when we say comment

1358
00:48:29,070 --> 00:48:31,304
and get involved, we're we're not talking about

1359
00:48:31,304 --> 00:48:33,625
put a blast out on whatever pages you

1360
00:48:33,625 --> 00:48:36,025
have. We're talking about going to the sources,

1361
00:48:36,025 --> 00:48:38,184
going to AMA, going to ASHA, going to

1362
00:48:38,184 --> 00:48:39,164
your state organization,

1363
00:48:40,025 --> 00:48:42,744
making comments there where there is leverage that

1364
00:48:42,744 --> 00:48:45,220
they can take and make our voices louder

1365
00:48:45,220 --> 00:48:45,960
as a collective.

1366
00:48:46,340 --> 00:48:47,780
Yep. And that's what we need to be

1367
00:48:47,780 --> 00:48:50,820
doing. Yep. Awesome. Okay. I'm gonna leave that

1368
00:48:50,820 --> 00:48:52,820
there. Do you have any final thoughts, Lisa?

1369
00:48:52,820 --> 00:48:54,260
I think I think we did a really

1370
00:48:54,260 --> 00:48:55,160
good job explaining

1371
00:48:55,460 --> 00:48:57,605
things that are going on. I'm gonna put

1372
00:48:57,605 --> 00:48:59,444
as many links as I can in the

1373
00:48:59,444 --> 00:49:00,964
show notes to this, you guys,

1374
00:49:01,525 --> 00:49:03,545
because I want to make it easy for

1375
00:49:03,605 --> 00:49:04,744
you to comment.

1376
00:49:05,605 --> 00:49:07,764
I am not going to be sharing templates

1377
00:49:07,764 --> 00:49:09,429
and things like that because I I do

1378
00:49:09,429 --> 00:49:10,570
not wanna be influencing

1379
00:49:10,869 --> 00:49:13,269
what other people should say. I'm just going

1380
00:49:13,269 --> 00:49:14,010
to say,

1381
00:49:14,309 --> 00:49:16,409
please do get in the conversation,

1382
00:49:16,869 --> 00:49:18,710
and that is where I'm gonna leave that.

1383
00:49:18,710 --> 00:49:20,230
So any any final thoughts, Lisa? I asked

1384
00:49:20,230 --> 00:49:21,349
you any final thoughts, and then I kept

1385
00:49:21,349 --> 00:49:23,385
talking over myself. So any final thoughts, Lisa?

1386
00:49:23,465 --> 00:49:25,945
I think, you know, using those resources, getting

1387
00:49:25,945 --> 00:49:26,925
to know those links,

1388
00:49:28,025 --> 00:49:29,864
really get intentional about what you're doing and

1389
00:49:29,864 --> 00:49:30,684
what you're practicing.

1390
00:49:31,945 --> 00:49:32,445
And,

1391
00:49:32,905 --> 00:49:35,144
I mean, we could talk for hours about

1392
00:49:35,144 --> 00:49:37,079
the here's how you can do the next

1393
00:49:37,079 --> 00:49:39,260
steps within your business, within your practice,

1394
00:49:40,440 --> 00:49:43,400
but that's a different focus, different conversation. This

1395
00:49:43,400 --> 00:49:45,000
is really about how do we advocate about

1396
00:49:45,000 --> 00:49:46,760
what's happening right now and where are those

1397
00:49:46,760 --> 00:49:49,799
sources. Yep. So use the resources, use the

1398
00:49:49,799 --> 00:49:50,299
links,

1399
00:49:50,675 --> 00:49:52,454
Talk to your other SLP friends.

1400
00:49:52,835 --> 00:49:55,315
Talk to your PTs and OTs also. They've

1401
00:49:55,315 --> 00:49:56,215
gone through this

1402
00:49:56,675 --> 00:49:57,255
a lot.

1403
00:49:58,275 --> 00:50:00,675
Your physicians have gone through it. They may

1404
00:50:00,675 --> 00:50:02,534
have words of wisdom for you

1405
00:50:02,835 --> 00:50:05,414
that are amazing. Yep. So

1406
00:50:06,079 --> 00:50:08,079
Alright. Thanks, Lisa. Appreciate you so much. I

1407
00:50:08,079 --> 00:50:10,559
always I always love talking to someone that

1408
00:50:10,559 --> 00:50:13,119
actually loves coding because I don't know, like,

1409
00:50:13,119 --> 00:50:15,280
ninety nine percent of other speech pathologists that

1410
00:50:15,280 --> 00:50:17,280
do not like it. So awesome. Thank you

1411
00:50:17,280 --> 00:50:18,734
so much for your for your time and

1412
00:50:18,734 --> 00:50:20,255
your energy and your knowledge. And like I

1413
00:50:20,255 --> 00:50:21,454
said, we will share as much of this

1414
00:50:21,454 --> 00:50:23,054
stuff in the show notes as we can,

1415
00:50:23,054 --> 00:50:24,574
as many links as we can gather for

1416
00:50:24,574 --> 00:50:25,934
you all, and and I hope this has

1417
00:50:25,934 --> 00:50:27,694
been a helpful conversation. So thank you so

1418
00:50:27,694 --> 00:50:29,474
so much. Yeah. Thank you.

1419
00:50:30,349 --> 00:50:32,369
And that's a wrap for this episode.

1420
00:50:32,750 --> 00:50:35,010
As always, thank you so much for listening.

1421
00:50:35,309 --> 00:50:36,829
If you'd like to download the show notes

1422
00:50:36,829 --> 00:50:40,769
from this episode, please visit swallowyourpridepodcast.com.

1423
00:50:40,989 --> 00:50:42,510
There you can also sign up for our

1424
00:50:42,510 --> 00:50:44,429
email list so that you'll never miss another

1425
00:50:44,429 --> 00:50:44,929
episode.

1426
00:50:45,425 --> 00:50:47,184
If you do like what you hear, then

1427
00:50:47,184 --> 00:50:49,764
please subscribe and leave a review on iTunes

1428
00:50:50,304 --> 00:50:52,065
or share it on social media with your

1429
00:50:52,065 --> 00:50:54,304
friends and colleagues because that is what keeps

1430
00:50:54,304 --> 00:50:55,684
these episodes coming.

1431
00:50:56,144 --> 00:50:57,940
If you'd like to be a guest, share

1432
00:50:57,940 --> 00:51:00,579
feedback or request a topic to be discussed

1433
00:51:00,579 --> 00:51:05,059
on the show, please email podcast@TeresaRichard.com.

1434
00:51:05,059 --> 00:51:07,059
Thank you so much for listening and we'll

1435
00:51:07,059 --> 00:51:08,280
catch you next week.