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View Diary: Managed Care Denies Coverage for Generic Albuterol, Will Only Cover----Name Brand Albuterol (20 comments)

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  •  Some of the rules make no economic sense. (15+ / 0-)

    I have a friend who is a speech pathologist here in Arlington, Texas. She has a private practice. Medicaid pays almost twice as much to home health speech pathologists for services under the same billing code as they do for services in a speech pathologist office! This has led to many children who do not require home health services being treated in the home! Last year the speech pathology association in Texas revised their billing codes. Medicaid was notified months in advance of the change. At the first of the year Medicaid deleted the old billing code

    Now Medicaid sends out a message instead of payment for services which are rendered which says: "We have not established a payment structure for billing under this code." My friend says she's been told by Medicaid that it will be "May before they decide what they'll pay for services under the new codes." They can't bill under the old code because it has been removed. This means that those who give speech pathology services to medicaid children will go for at least 5 months (and probably longer) before they are paid for their services. Few small practices (medical or otherwise) can survive that long without payment for services!

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