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The Health Care Economics and Advocacy Team (HEAT) has been a unit within the Government Relations and Public Policy (GRPP) Cluster since 1981. HEAT focuses on issues affecting speech-language pathology and audiology related to health care reimbursement and coverage regulations, private health plans, and procedure and diagnostic coding. HEAT provides economic data and analysis of trends, policies and procedures related to private and public sector healthcare insurance, utilization management, and reimbursement to ASHA members and the public. HEAT advocates to improve regulatory coverage and payment policies in the Medicare and Medicaid programs, and private health plans for speech-language pathology and audiology diagnostic and rehabilitative services.
CPT Coding and Reimbursement
HEAT coordinates adding new codes and procedural values for audiologists and speech-language pathologists through the American Medical Association's Current Procedural Terminology (CPT) Editorial Committee and Relative Work Value Update Committee (RUC). HEAT collaborates with the ASHA Health Care Economics Committee (HCEC) to ensure that the CPT codes and their payment rates are as appropriate and equitable as possible for the professions. HEAT assists in obtaining data describing the resources needed to provide speech-language pathology and audiology procedures, submits written reports to the RUC, and supports the HCEC members presenting the data and other information to the AMA RUC. HEAT collaborates with the HCEC related to the AMA CPT Editorial Panel by obtaining information to determine the need for new or revised speech-language pathology and audiology procedures listed in the CPT Manual.
ICD-9-CM Coding
HEAT works closely with the HCEC and ASHA Special Interest Divisions in the development of diagnostic coding recommendations. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are reviewed and revisions are recommended to the ICD-9-CM Coordination and Maintenance Committee of the Centers for Disease Control and Management. Most recently codes were proposed to allow for better diagnostic descriptions of voice and fluency disorders.
Medicare
HEAT advocates for ASHA-developed recommendations with the Centers for Medicare and Medicaid Services (CMS) officials. For example, each year HEAT analyzes and develops comments on the proposed Medicare Physician Fee Schedule so that coverage of audiology and speech-language pathology services is appropriate and payment levels are equitable. HEAT provides Medicare coverage advocacy by developing background papers, developing strategies, and, meeting with regulators to present the position of audiologists and speech-language pathologists.
In addition, HEAT collaborates with the ASHA-State Medicare Administrative Contractor (SMAC) network; a state-based advocacy group that develops Medicare reimbursement advocacy strategies within each state on key issues and processes. The Team revises the Medicare Handbook for Speech-Language Pathologists and the Medicare Handbook for Audiologists on an annual basis.
Private Health Plans
HEAT has also undertaken initiatives to improve coverage of audiology and speech-language pathology services in private health plans (i.e., employer sponsored health insurance), including advocacy, appeals, and information for ASHA members and consumers, such as efficacy reports for major communication and related disorders and checklists for consumers and members to use when reviewing health plans and advocating for change. It also supports private plan advocacy by writing and meeting with benefits administrators, health plan officials, and labor representatives, as well as preparing publications that are for sale through the ASHA catalog (e.g., Health Plan Coding and Claims Guide) and other advocacy materials. HEAT provides speech-language pathology and audiology actuarial data to assist in local negotiations.
This year HEAT will staff the ASHA Ad Hoc Committee on Speech-Language Pathology Medical Review Guidelines, which will create a document as a resource for private sector health plans to use in reviewing speech-language pathology claims. HEAT coordinates the State Advocates for Reimbursement (STAR) network; a state-based private health plan advocacy network that develops private health plan reimbursement strategies within each state on key issues and processes. As part of the ASHA's Strategic Pathway to Excellence, last year saw the addition of state data to the report so that STAR members can better negotiate at the local level.
Medicaid
HEAT maintains current Medicaid regulations so that members can ensure that their states are covering Medicaid services consistent with federal requirements. A new page will be added to the site in 2009 that includes links to each state's website containing relevant Medicaid information.
Communication
HEAT staff routinely write the Bottom Line columns found in The ASHA Leader. They also provide analyses of current reimbursement and coverage issues in the Leader. HEAT staff developed a new webinar regarding Medicare speech-language private practice enrollment and billing issues. Staff are frequent presenters at state association conventions and workshops. Lastly, HEAT maintains a site on reimbursement and health care economics topics.
Health Care Economics and Advocacy Team
National Office Staff Updates
The following individuals are new to the ASHA staff since March 18, 2009:
- Rita Desjardins, Member Receipts Coordinator
- Paul Farrell, Associate Director, Audiology Practices
- Karen Taus, Brand Manager
The following staff has changed positions within ASHA:
- Karen Cohen, Manager, CE Provider Services (formerly A/R Customer Services Representative)
The following individuals have left ASHA to pursue other opportunities:
- Luella Cannon, Board of Directors Manager (retired)
- Galia Holland, Senior Administrative Assistant
The Next Executive Director Update: How is the economy affecting audiologists and speech-language pathologists?
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