Advocacy in Action July/August 2010

Published: 2010-07-29

NCSHLA Advocacy In Action

JULY/AUGUST 2010

·         LEGISLATIVE ADVOCACY DAY - Over 30 SLPs from all across North Carolina attended our First Annual Legislative Advocacy Day on May 18, 2010.  Our group met in Raleigh to educate Legislators about the need for speech-language pathology and audiology services and the need for funding to support them.  Our members were well-received and the experience was a great success for everyone who attended.  Thank you to those who supported these long-term efforts!  Please, watch for the opportunity to attend and participate in 2011 – our advocacy efforts will be even more necessary as federal funding is less available for struggling state budgets.

·         CONTINUED ADVOCACY NEEDED - Please, continue to communicate with our US Congressmen/women regarding the need for continued federal funding for North Carolina.  If they do not pass the bill that includes extending the Federal match dollars for our State Medicaid program, significant reductions to program benefits and provider reimbursement rates could result as early as January 2011.  Please educate and communicate with your US Congress Representatives and Senators – they represent you!

·         NCSHLA Fall Conference, September 24-25, Greensboro, NC.  See website for registration and conference session details.  www.ncshla.org

o        Special Session:  Saturday, September 25^th – Clinical Speech-Language Pathology Documentation session focusing on medically necessary speech-language pathology evaluation and treatment documentation.  General information about the need for documenting the clinical need for and delivery of skilled intervention through the formal Evaluation, Plan of Care and Daily Visit record.

o        Other Great Sessions for Audiologists and Speech-Language Pathologists – REGISTER NOW! 

·         CLARIFICATION FOR NC MEDICAID IPP PROVIDERS -  Under Federal direction, the Program Integrity Section of the Division of Medical Assistance is required to conduct post payment validation (PPV) reviews of Medicaid paid claims.  For NC SLP and Audiology providers in the Medicaid program, this federally mandated process was contracted to The Carolinas Center for Medical Excellence (CCME) and implemented in May 2010.  The purpose of PPV is to determine whether documentation for services meets federal and state guidelines for medical necessity, skilled intervention and program compliance.

Specifically, is it well documented that the services provided were:

 1) Medically necessary?

2) Was skilled intervention required for the delivery of the service?

3) What skilled interventions were delivered during the session?

4) Were all NC Medicaid program service and documentation requirements followed?

For provider reference, North Carolina Medicaid ‘s Independent Practitioner and Outpatient Specialized Therapies documentation guidelines and requirements are located in several places and must be collectively reviewed, interpreted and implemented on the provider level to insure compliance:

·         NC Division of Medical Assistance, Basic Medicaid Billing Guide April 2010, Section 3, Medicaid Provider Information, page 4, Medical Record Documentation.

o        http://www.dhhs.state.nc.us/dma/basicmed/Section3.pdf

·         NC Division of Medical Assistance, Program Policy Manuals:

o        10A – Outpatient Specialized Therapies, 12-01-2009, Requirements (eligibility, service delivery and documentation) throughout manual, specific documentation and compliance sections 5.0, Requirements for Limitations on Coverage and, 7.0, Additional Requirements.

o        10B – Independent Practitioners, 06-01-2010, Requirements (eligibility, service delivery and documentation) for providers throughout manual, specific documentation and compliance sections 5.0, Requirements for and Limitations on Coverage and, 7.0, Additional Requirements. 

o        DMA 10A and 10B:  http://www.dhhs.state.nc.us/dma/mp/index.htm

·         Carolina’s Center for Medical Excellence (CCME) published Documentation Standards for PPV:  https://www2.mrnc.org/paservices//Documents/NCPATS_PPVDocumentationStandards.pdf

NOTE:  The former CCME PA Review Audits were simply a ‘review’ (without recoupment) of whether the services requested via Prior Authorization were delivered as requested and authorized.  These were NOT a clinical review/audit of whether policy and documentation requirements were met by the provider.  Therefore, comparisons of purpose, process and/or results between former and current CCME reviews aren’t equivalent.  However, providers with concerns regarding review results are encouraged to follow the administrative appeal process.  

Thank you for being a valued member of the NCSHLA organization – our professional association is as strong as our membership and we are grateful for your mutual support.  Please, encourage your fellow professionals to join NCSHLA so that our representation is larger and stronger.  Plan now to attend the NCSHLA Fall Conference!

Respectfully submitted,

Jeri Bates, Member

NCSHLA Professional Affairs Committee

Advocacy Subcommittee