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Oklahoma has a large population living in rural areas where it is difficult to fill school speech-language pathologist (SLP) positions. To meet this need, telepractice has been used in rural Oklahoma school districts since 1999. Medicaid policies have allowed schools to receive reimbursement for speech therapy provided by onsite therapists; however, reimbursement for speech telepractice was excluded. The current project measured the effectiveness of a speech telepractice program so this policy could be revised. Speech and language skills of 578 children, grades PreK–12, were followed over one of two school years and were rated using Functional Communication Measures (FCM) established by the American Speech Language and Hearing Association (ASHA). Our data show that 67–87% of the children advanced by one or more levels on three common FCM scales. These changes are similar to, or greater than, what was reported in a large sample of students compiled by ASHA's National Outcomes Measurement System (NOMS) with clinicians who worked onsite in schools. Average weekly treatment time was also less in our teletherapy practice than what was reported in the reference database. Therefore, the current study demonstrates that speech telepractice is an effective and efficient method of delivery for the school age population.

Speech-language pathologists (SLPs) who treat patients with vocal disorders find they are the exception —rather than the rule—when it comes to Medicare policy. This article addresses statute, regulations, and policies related to acoustical assessments, endoscopy, electronic speech aids, and tracheo-esophageal prostheses (TEPs). Acoustical assessments have limited recognition in the Medicare program and are only reimbursed in certain states, despite advocacy efforts by the American Speech-Language-Hearing Associaiton and members of the State Medicare Administrative Contractor (SMAC) Network. For endoscopy evaluations, confusion is still prevalent related to the level of physician supervision required, primarily due to the changing policies in 2011. Electronic speech aids are a benefit that is often forgotten, though the national policy allows relatively broad coverage. Finally, TEPs are the subject of SLPs, patients, manufacturers, and Congressional attention due to their limited available secondary to poor reimbursement rates and a 2010 enforcement of distribution policy. Clarification regarding the provision of traditional Medicare services (not Medicare Advantage or supplemental plans managed by private companies) and statute is discussed.

Speech-language pathologists (SLPs) have an obligation to accurately record the services that they provide according to the guidelines from the patient's payer, meeting the expectations in the state's practice act and in keeping with the employer's policies relative to billing practices. Accurate, complete, and timely documentation of dysphagia services is a requirement of the ASHA Code of Ethics, as well as an expectation of employers and third-party payers, and is subject to review when determining coverage for claims submitted. Acquiring a familiarity with the myriad of policies, rules, regulations, and expectations can be likened to finding a way through a maze. Clinicians need to balance effective dysphagia service delivery with the demands of the various payers and the regulatory requirements in the SNF to practice in an ethical manner.

Whether in our professional or private lives, we are all aware of the system wide efforts to provide quality healthcare services while containing the costs. Telemedicine as a method of service delivery has expanded as a result of changes in reimbursement and service delivery models. The growth and sustainability of telehealth within speech-language pathology and audiology, like any other service, depends on the ability to be reimbursed for services provided. Currently, reimbursement for services delivered via telehealth is variable and depends on numerous factors. An understanding of these factors and a willingness to advocate for increased reimbursement can bolster the success of practitioners interested in the telehealth as a service delivery method.

Clinicians work with older residents who have not only multiple physical limitations, but cognitive loss, communication deficits, dysphagia, and multiple medical diagnoses. They must work within procedural, regulatory, and reimbursement systems that challenge them to provide optimal resident care. In this article, the authors will discuss some specific challenges brought forth by clinicians in response to a clinical scenario and will provide information and feedback from several health-care consultants.

Making the move to private practice can be an exciting and challenging proposition. There are many practical, professional, and personnel issues to consider. This tutorial provides practical suggestions for transitioning into a private practice including considerations for referral base, office space, personnel, and practice management. In addition, two major health-care coding systems are described, and the relationship of these systems to clinical documentation (Medicare Physician Fee Schedule and equitable reimbursement) is explained. Information about the use of coding edits and coding modifiers is provided. Also included in this tutorial is a brief discussion of the impact that Public Law 110-275: Medicare Improvements for Patients and Providers Act of 2008 has had on the valuation of speech-language pathology procedure codes, particularly for assessment and treatment of individuals with voice disorders.

The American Speech-Language-Hearing Association (ASHA) supports the use of telespeech (also called telepractice) to expand access to speech-language pathology and audiology services; however, widespread acceptance has been influenced by the reluctance of payers to reimburse this method of service delivery. At the present time, schools are leading the way in implementing telespeech, while adoption in health-care settings lags behind. This article provides a brief background about ASHA's activities with regard to telepractice and discusses the status of reimbursement for telespeech in various settings, including schools, private insurance, Medicare, and Medicaid.

Special Interest Division 3 continues to focus on increasing awareness among affiliates of correct coding initiatives, updates on reimbursement guidelines, and a resource for questions regarding coding and reimbursement. In November 2009, Division 3 hosted an update on reimbursement issues for voice clinicians at the American Speech-Language-Hearing Association's (ASHA) annual convention in New Orleans. The purpose of this article is to summarize a number of case study highlights that were presented at the convention by Sandy Schwartz, Dee Nikjeh, Mary Sandage, Mark Kander, and Edie Hapner