Quintessence is now a Firstsource company! Learn More

The Basics of Speech Therapy Billing and Coding

While speech therapy can be an exclusive department in some hospitals, speech therapists have their exclusive practices in most cases. This gives them the flexibility to help more individuals in the capacity that works for them. In this case, a third-party medical billing services company is what they need to handle their backend billing and coding needs.

Why is speech therapy medical billing and coding critical for business success?

There are two parts to healthcare services – frontend services and backend services.

Frontend services include patient experience and the diagnoses and treatments offered.

Backend services include capturing charges, creating bills, generating codes, handling payer denials, payment posting, and general revenue cycle management services.

More than 90% of patients who walk into a speech therapy clinic are covered by some type of insurance. This means that the insurance companies become the primary payers. A medical billing services company generates claims that can be processed by these payers quickly so that they can reimburse for the services rendered.

Without the right billing and coding service, the claims are sent out seamlessly, the rate of denials is reduced, claims are reimbursed on time, the A/R is diminished, and the revenues are protected.

If you are a new speech therapy practice or have always struggled with handling billing and coding right, you may benefit from hiring a third-party medical billing and medical coding services company that can handle your billing and coding needs with expertise.

The common codes used in speech therapy billing and coding

A medical coding services company may handle speech therapy charges using the following codes.

Type Codes Used Coverage
CPT 92507 Speech/hearing therapy
CPT 92521 Evaluation of speech fluency
CPT 92523 Speech sound lang comprehension
CPT 97129 Therapeutic interventions that focus on cognitive functions
CPT 97533 Sensory integration
CPT 92612 Endoscopy swallow test

These are just some commonly used Current Procedural Terminology (CPT) codes. Several such codes need to be used by the coders to ensure the claims are captured and processed right.

Commonly used speech therapy modifiers

A medical coding services company must also focus on the modifiers and not just work on generating codes. Modifiers are used whenever there is a slight change to the service provided and the service invokes a higher-than-normal charge.

Here is a list of common modifiers used in speech therapy coding.

  1. GN modifier – this denoted that the particular treatment was offered under the OP speech-language pathology plan of care.
  2. U2 modifier – re-evaluation of oral and pharyngeal swallowing functions.
  3. U5 modifier – service was rendered by a professional licensed therapist.
  4. 22 modifier – there was a need for excess efforts to offer the service than usual. This modifier needs to be followed through with documentation.
  5. 52 modifier – only partial service was offered under the physician’s discretion.

Measuring time units in speech therapy billing

Another essential factor that any third-party medical billing services company should be aware of is the measurement of time units.

Since speech therapy is time bound and each client could need extended periods of consultation and treatment, it is imperative that the billers capture the time units precisely.

Time spent in offering the service is measured in terms of units. One unit equals anywhere from 8-23 minutes of service. The following table givou a clear idea of measuring time units in speech therapy billing.

Units Period of service offered
1 8-23 minutes
2 23-38 minutes
3 38-53 minutes
4 53-68 minutes
5 68-83 minutes
6 83-98 minutes

This time measurement is for face-to-face sessions and do not include the time spent waiting for the expert or post-consultation waiting periods.

The medical billing services company must get the right documentation in terms of time spent with the patients in order to create the right bills. All untimed CPT codes would be considered as only one unit. If the expert spends more time with the patient, this leads to revenue losses.

Top causes of denials in speech therapy billing and coding

Here are some top causes of denials in speech therapy billing and coding.

  1. Incorrect or insufficient documentation

One of the main reasons for denied claims in speech therapy billing and coding is incorrect or insufficient documentation. Documentation includes both patient demographics and data entered by the physicians to support their decisions.

  1. Errors in capturing time units

There is a common way a medical billing services company can contribute to time unit errors and increase the chances of denials.

Let’s assume the speech therapist spent 25 minutes with the patient. The billing company, intentionally or unintentionally, captures the time units as 3. Now, there would be a mismatch in the physician report and the captured charges, which can lead to denials.

  1. Incorrect codes

Another simple reason why a speech therapy claim gets rejected is due to incorrect codes. Codes can be generated wrong due to various reasons. Coder errors, problems with the coding tools, lack of right coding auditing, or partial documentation that the coders end up following can all lead to coding errors and denials.

  1. Incorrect modifiers

The medical coding services company can end up increasing the rate of denials if the coders aren’t well-versed in using modifiers.

All the following issues can cause modifier-based denials.

  • Lack of use of modifiers
  • Overuse of modifiers
  • Using modifiers in places not needed
  • Using wrong modifiers
  1. Delayed submission of claims

A straightforward cause of denials is late submission of claims. Once service has been provided, there is a certain period before which the claims need to be reimbursed. If that doesn’t happen, the payers can refuse payment, and the claim must be written off.

Conclusion 

Speech therapy is becoming a ubiquitous healthcare service for young and growing children and individuals recovering from injuries and diseases. If you have a specialty practice dealing with speech therapy, definitely consider hiring a medical billing services company to handle your billing needs. This would streamline the process and help improve revenues. RCM experts believe that precise billing also helps improve patient experience.

Quintessence Business Solutions and Services is your perfect medical billing and coding partner. We specialize in handling speech therapy billing and coding. Our team can take over your complete RCM operations and ensure the revenues flow well-planned and intentional while you focus on expanding your business.

ENQUIRE NOW