Monday, June 15, 2015

The 3:1 Therapy Model: Medicaid Billing

If you are feeling overwhelmed and overworked, this series of posts is for you! It might be time to start talking to your administration about ways you can improve your working conditions. You can read the introduction post here and the Getting Started post here. This is the third post in this series!

We all know that Speech Language Pathologists are hard to come by, meaning that you often get more work piled on than you can feasibly do. A lot of times it's viewed as necessary to get our students' needs met. I'm lucky that I work in a state that has a cap of 60 students per caseload. But we've all heard the horror stories of SLPs with 80 or more kids on their caseloads.  This might be a way to help manage your caseload if you're finding yourself in this situation! Even if you don't have a huge caseload, you may have other factors that make your job overwhelming. For example, our district has a VERY high percentage of students receiving Medicaid - meaning that we must spend A LOT of time billing Medicaid. We also have a high turnover rate, which generally means more and more training and supervision of Clinical Fellows. And all of our SLPs travel to at least 2 buildings - most have 3 buildings they service. All of these factors, led our district to use the 3:1 Therapy Model. It's been working for the past 6 years while maintaining our previous dismissal rates (in fact, they have improved!). If this is you - keep reading!

As I previously stated, a large portion of our students receive Medicaid benefits. This is a good source of income for our district. This is also the case in many surrounding districts. Because of this, there were a lot of questions about how Medicaid would be billed using this new model. But, we actually found that this model is much more Medicaid friendly!

As I explained here, therapy minutes used to be written in a minutes per week style. Because Medicaid will only allow you to bill for the minutes written in the IEP (at least this is the case in my state), this meant if the sessions were not made up within the week they were missed, they could not be billed. For example, and IEP is written for a total of 40 minutes per week. You miss a session in Week One, so you can only bill for 20 minutes. The next week, you see the student for their 40 minutes and you make up the session from last week - making a total of 60 minutes. But you can still only bill for 40 minutes because that was all the was listed in the IEP. With the 3:1 model, minutes are written in a minutes per month style. Because of this, you can bill for make up sessions as long as they are made up within the month. This gives you much more flexibility to make up those sessions. Which means more money for your school - which means happy administration!

Something to Consider
The 3:1 Model is technically a 4 week cycle, so it will not fit perfectly into each month. We bill our minutes per month by calendar month regardless. Most months, I actually see students more than I can legally bill for. 

DISCLAIMER: Once again, I am NO WAY telling you that this is the correct way to do this. It works for us here, but you need to check with your STATE'S MEDICAID POLICIES and your DISTRICT'S SPECIAL EDUCATION POLICIES. Make sure you do your research, as these processes do vary from state to state!

If you're still thinking this might be for you, keep checking back for our next post - What Does Student Support Week Look Like?

1 comment:

  1. I am very happy to your medicaid plan, I think it is very exclusive enterprise Thanks for sharing this great article.Great information thanks a lot for the detailed article.That is very interesting I love reading and I am always searching for informative information like this.
    Medicare Billing