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Can I Bill for Multiple Evaluations?

Dee Adams Nikjeh, Ph.D., CCC-SLP

June 16, 2014

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Question

I have one hour allotted for evaluation.  My facility is “encouraging” me to bill for multiple evaluations, fluency and speech sound production or speech and feeding (which is a clinical swallow eval).  If I look at both areas with a patient, should I have reservations that one hour for two assessments may not be appropriate?

Answer

These procedure codes are not timed codes.  To do multiple evaluations within one hour is not ethical.  I do not believe that you could do a fluency and a speech sound production and an evaluation all in one hour.  Your minutes would not support that.  They are not timed, so you can usually do at least a couple of them, perhaps within an hour, depending on what those two are.  Again, it is not the time.  We have to get away from valuing our profession by the minutes we spend.  Within the next few years our payment is going to come down to the value that we contribute, the functional improvement that the patient makes.  It will not have anything to do with the number of minutes that we have spent.  All I can say to you and to other people who are in that situation is, you need to speak up for yourself.  You are a professional.  It is your name that goes on those reports, and when you find yourself in an uncomfortable situation, that you do not feel like you can speak up, then I would encourage you to contact ASHA’s Healthcare Economics Advocacy Team at reimbursement@asha.org.  They may be able to give you advice and assistance on how to handle that.  

Dr. Nikjeh is co-chair of the Health Care Economics Committee of the American Speech Language and Hearing Association (ASHA). She has appeared before the U.S. Dept of Health and Human Services on behalf of ASHA to propose new diagnostic codes and modifications of existing codes for the benefit of speech-language pathologists.  Dr. Nikjeh is an ASHA advisor to the American Medical Association Health Care Practitioner Advisory Committee where she has presented speech-language pathology procedure codes for valuation of professional service.


dee adams nikjeh

Dee Adams Nikjeh, Ph.D., CCC-SLP

Dr. Nikjeh is co-chair of the Health Care Economics Committee of the American Speech Language and Hearing Association (ASHA). She has appeared before the U.S. Dept of Health and Human Services on behalf of ASHA to propose new diagnostic codes and modifications of existing codes for the benefit of speech-language pathologists.  Dr. Nikjeh is an ASHA advisor to the American Medical Association Health Care Practitioner Advisory Committee where she has presented speech-language pathology procedure codes for valuation of professional service. Her clinical experience spans thirty years.  She provides services for patients of West Coast Ear, Nose and Throat Association specializing in endoscopic procedures for evaluation and management of voice disorders.  Dr. Nikjeh is a consultant for the United States Dept. of Justice, Civil Division-Fraud Section and is an associate of Fearon & Levine, a national consulting firm that focuses on practice management and payment policy in outpatient rehabilitation settings. Dr. Nikjeh is an ASHA Fellow and has served on ASHA's Legislative Council and Executive Board of the Council of State Association Presidents. She is a past-president of the Florida Association of Speech Language Pathologists and Audiologists.


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