Billing Medicaid vs. Medicare For Speech Therapy

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I recently received an e-mail from an Independent Clinician asking about whether or not individual SLP’s could bill Medicaid (i.e. if they weren’t part of a medical institution). The issue of billing Medicare vs. Medicaid is fairly new for Speech-Language Pathologists.

For Medicare and Medicaid you will need to:

1. get a National Provider Number
2. apply to become a provider
3. provide proof of licensure, liability insurance, employment, references, etc.

Medicaid…

is a state issue- as far as whether you can bill through an affiliation with a facility vs. on your own should be addressed by contacting your states Medicaid department (to find google search: Medicaid + state name).

Once you’re on the site, search for “provider.” Depending on the site, you will either get an easy to follow explanation about how to become a provider OR you should be able to locate a phone number of who to ask.

Medicare…

As of last summer, speech therapists can apply to become Medicare providers. Again, you’ll need to have an NPI number and fill out the form. The form is a bit confusing: it is for ALL health care providers and isn’t always clear what we should do about sections that seem to be for physicians. I will cover this in-depth in an upcoming Special Report.

Please be advised that reimbursement rates for Medicare and Medicaid patients vary by state and aren’t as high as we would like. You will find these out once you’ve applied. Rest assured, ASHA has lobbyists in Washington attempting to increase reimbursement rates. We will continue to hope that they come through!

I found a few sites that might be helpful:

Helpful Links

State Medicaid Site Directory:

http://www.healthsymphony.com/medicaid.htm

Medicare provider enrollment site:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/

What has been your experience with Medicare and/or Medicaid?

Image: FreeDigitalPhotos.net

Related posts:

1. Check out the ASHA Forums
2. May is Better Speech and Hearing Month