Preparing for the 92507 change: What pediatric & speech clinics need to know

Casey: [00:00:00] Hello, everyone, and welcome to today's webinar on the upcoming 92507 coding change and what pediatric and speech therapy clinics need to know. I'm Casey Francis, the manager of educational content here at Prompt Health, Dean of Prompt University, and a former speech therapist myself. So like many of you, I've had questions about what this means for therapists, for clinic operations, and patient care, and I'm really excited to learn alongside all of you all from our amazing guests today to help bring this information to our broader therapy community.

So by the end of today's webinar, you should leave with a clear understanding of what's changing, what it means for your business, and what actions you can take immediately. Uh, just a few housekeeping items before we get started. This session is going to be recorded and will be distributed to all registrants.

Please use the Q&A feature for questions. There's a little button at the bottom of your Zoom screen where you can send in questions, and we'll try to save some time at the end, um, to answer some of those. Any that we don't get to today, we will follow up with you afterwards though. And, um- So feel free to send in anything that you've got, and we will follow up with you.

And now for the fun part, I'd love to introduce our guests. They each bring a wealth of knowledge and experience in the outpatient industry, and we're just so happy to have them here. [00:01:30] Thank all of you for taking the time to be here with us. First is Nancy Mura. She's the founder of Pizza Palooza, the largest support and resource center for private practice owners in the US.

She's the creator and producer of conferences that teach systems to stabilize and/or expand private practices, and she established the Let's Talk Private Practice, Incorporated, offering custom management coasting th- coaching that aligns the practice owner's personal vision with both their passion and business strategy.

Thank you, Nancy, for being here. Hi. Hi. And

Nancy: welcome. Thank you so... Oh, thank you so much. It's always great to be here, and hi to everyone that's joining and taking this time out of their busy day to hear about this. And the only thing I would say besides hello is everybody breathe. We're gonna get through.

Casey: I love that.

What a great start. Um, we also have Stephanie Valentine. She's the owner of Therapy Link Solutions with multidisciplinary pediatric therapy practices serving the Oklahoma City area. With more than 20 years of experience in pediatric therapy, she also serves as an advocate for pediatric therapy providers across Oklahoma through her work with the Oklahoma Pediatric Therapy Advocacy Group.

Hi, Stephanie, and thank you for joining us.

Stephanie: Good morning. Thank you for having me.

Casey: And fun fact about Stephanie, your mom was an SLP, is that right?

Stephanie: Yeah. Yeah.

Casey: That is awesome. Retired, yeah.

Stephanie: Yeah. So I [00:03:00] was kind of born and raised in the industry.

Casey: Right. We've... It's just lovely. Love seeing all of our speechies all around.

And then we also have Rick Gawenda, who is a licensed physical therapist with 35 years of experience and the founder and president of Gawenda Seminars and Consulting. He's an educator and consultant specializing in basically everything outpatient therapy, compliance, coding, billing, documentation, revenue enhancement, denial management, remote therapeutic monitoring, and practice management.

Um, thank you so much, Rick. I know you are very busy all the time, so we appreciate you, um, joining us here today.

Rick: Thanks. Thanks for having me, and, uh, I, I will echo what Nancy said. Uh, the SLPs and the owners of practices, you're gonna be okay. It's, it's all gonna work out. It'll be okay.

Casey: Love that. Love that sentiment.

Um, and last but not least, we have Kelly Brown. She is on our Prompt team. She's a leader within Prompt's innovation and product ecosystem focused on documentation workflows, coding intelligence, compliance monitoring, and AI-enabled clinical operations, so she's gonna be able to speak to what Prompt, um, has prepared for us later today.

Hi, Kelly. Thanks for joining.

Kelly: Hi, Casey. Thanks so much. Yeah, excited to be here and to talk about how we at Prompt are prepared to help everybody through this, um, transition and to make it as easy as possible. So thanks for having me, Casey.

Casey: Yes. Okay. So now that everybody knows a little bit about [00:04:30] us, we'd love to know a little bit more about who's joining us today in the audience.

So we have a poll that we'll send out to see whether folks attending are mostly treating pedes, adults, or both. Um, and while y'all get that poll completed, I'm gonna bring up my screen here so we can have a little slide deck while we go through some of this stuff. Okay

There we go. Okay, so it looks like from these, y'all can see these results, we've got Mostly peds here today. Um, and then a lot of a mix of both, and some that just do a little bit who do just adults, so that's great to know. Thank y'all for, um, answering those. So again, the question today, first we wanna just clarify the topic.

For those who haven't been following this closely, what's changing with SLP coding? Um, and so I'd love for Rick to let us know kind of where we are today, what's changed. Walk us through the new rules, because I know you are an expert on this, Rick. So can... I will be your Vanna White- Okay ... and go through the slide deck.

But go for it.

Rick: So, so what's changing, I- I'm sure you all know, is 92507 is being de- deleted at the end of 2026, and people [00:06:00] wonder, well, how'd this come about? Well, there's a committee called, it's the RUC, Relativity, uh, Assessment Workgroup, and they look at s- utilization of CPT codes, of CPT codes that are billed of 10,000 units or more in a calendar year.

Well, in 2017 to the Medicare program, uh, 92507 was billed about 290,000 times. Five years later, 2022, it went up to about 550,000, so almost 100% increase. Wow. Well, because of that significant increase, uh, this workgroup, the... and it's funny, the Relativity As- Assessment Workgroup, the acronym is RAW. You know, RAW then referred this issue to CPT, the American Medical Association, so the AMA creates the CPT codes, et cetera.

Uh, and they referred it to CPT, uh, to look at do there need to be updates to the CPT codes to better reflect what SLPs are now doing compared to when this code came out years and years ago? Because really, uh, this code has not seen any significant changes in, in over 16 years. So obviously, as you all know, it went through the process and it was determined, yes, you know, we do need new CPT codes to better describe what SLPs do treatment-wise, which now takes us to the, the 10 codes you see.

And it's kind of f- funny, a- and again, I was expecting most of you [00:07:30] to be pediatrics, uh, because obviously that's where I think most of the fear lies right now, the uncertainty. So I know a lot of you do Medicaid. To put it in perspective, uh, 92507 to the different Medicaid programs around the country was billed about 12 million times in 2018.

Uh, in 2022, it was billed 22 million times. Wow. So obviously that's gonna continue to increase as well and, you know, 92507 was kind of the catch-all CPT code for everything you saw a child or an adult for, and now you're gonna see these 10 new codes, uh, will break everything up into kinda- I don't want to say silos may not be the best word but we'll use silos as it is taking it into specific codes.

Which you see here on this slide. So, you know, you have 10 new CPT codes that will become effective January 1 of 2027. Uh, it's what I call five base codes and five add-on codes. So if you go back in 2014, that's when you got rid of 92506, which your ca- which was your catchall evaluation CPT code, and you got four new eval CPT codes that were very specific.

Well, now you're gonna see the treatment codes kind of mirror those evaluation codes. So one of the new codes you see here will be for fluency, and there's gonna [00:09:00] be a CPT code to treat fluency for the initial 30 minutes, a separate CPT code for fluency for each additional 15 minutes you do beyond the initial 30.

There'll be now a specific CPT code just for speech sound production for the initial 30 minutes. Again, an add-on code for each additional 15 minutes. There'll be yet a third base code just for language comprehension and expression, initial 30 minutes, an add-on code for each additional 15 minutes. And then there'll be another code for, say, voice and resonance, initial 30 minutes, another code each additional 15.

And then the big one, which I think is gonna get used a lot, it's the, what I call the combo code. It's gonna be for speech sound production and language comprehension expression, initial 30 minutes, and then another code for each additional 15. So basically, what they did is they took your eval codes and turned them into treatment codes

So in order to bill the, the base code, uh, you're gonna have to do it for at least 16 minutes. So there's that past midpoint. So the American Medical Association defines midpoint, uh, as once you pass the midpoint. Now, I know technically for 30 minutes, I know technically 15 minutes and 31 seconds is past midpoint, [00:10:30] but AMA will say 16 minutes.

You do 16 minutes of a 30-minute time-based code, you're gonna be ab- able to bill one unit of that base code. Now, to bill two separate base codes, to bill, um, just, you know, say a child has fluency issues and say language comprehension expression issues, to bill the base code for fluency and the base code for language comprehension expression, you're gonna have to provide at least 16 minutes of intervention addressed specifically for fluency, and then at least a different separate 16 minutes of interventions focused on language comprehension and expression.

So this is gonna be the tough part for SLPs because I know a lot of times as you're treating a child, an adult, you're kinda treating them as a whole, and you're kinda going back and forth between things, well, now you gotta try to keep track of the minutes now.

Casey: Right.

Rick: And then... Go ahead, Casey.

Casey: Oh, I was just saying, yeah, that's something that as an SLP we're definitely not used to, doing all the math that this entails as we go.

Um, but here's a little how time maps to units that y'all can look at, um, and keep handy to just kinda wrap your brain around what this is gonna look like logistically, um, with these units for base codes and adds o- add-ons.

Rick: Yeah. So, so for example, if you're seeing [00:12:00] a patient for speech sound production and language comprehension expression, to bill both the initial 30 minutes and at least one unit of the add-on code, you're gonna have to do at least 38 minutes of interventions under that CPT code, because you gotta do the whole 30 for the base code, and then eight minutes is past midpoint of a 15-minute code that then allows you to do that additional base code.

Casey: Right. Um, and this kinda just explains that a little further. The midpoint rule applies to the base code and to thinking about it the same way with the add- add-on.

Rick: Correct.

And this is kind of what I had said in a, in the previous example. I was ahead of the slides here a little bit. Uh, but again, to bill two base codes, you have to do at least 16 minutes of interventions directed at each base code, whatever it's described by. So this was the example of you provide at least 16 minutes of interventions to address the child's fluency disorder, and then a separate at least 16 minutes to address the child or adult's, you know, language, uh, deficits

Casey: Exactly.

And this will be an example of the 32-minute minimum for two codes is not met for 25 minutes of combined fluency language treatment. So-

Rick: And keep, and keep in mind you can't [00:13:30] combine. So, you know, if you only did 13 minutes of fluency and 12 minutes of language, y- you don't get to bill anything. So, you know, it's not like, you know, the eight-minute rule.

You know, I know some of you are familiar with PT and OT, and we have the 15-minute time-based codes where, you know, Rick could do five minutes of therapeutic exercise, five minutes of neuromuscular education, and five minutes of therapeutic activity, and under Medicare's quote eight-minute rule, I get to add those minutes up.

It's 15 minutes, I get to bill one unit. Well, the eight-minute rule only applies to CPT codes timed in 15-minute increments. The eight-minute rule does not apply to untimed CPT codes, 30-minute timed CPT codes, or one-hour time-based CPT codes. So ma- you know, many Medicaid programs and some commercial payers follow Medicare's eight-minute rule, but that's only for 15-minute time-based codes.

So this example here to the right, uh, that 25 minutes to bill one unit of a base code, 16 minutes would have had to have been done on either fluency or language, and then the other nine could have been for the other code. So that's gonna be very important to remember.

Casey: Yeah. It is interesting how some of this does feel more similar to the OT and PT, uh, the way they think about their sessions, and we'll talk about that a little bit more later about deciding what to code, but it's really important [00:15:00] to keep that distinction about the actual- how it actually maps out into units.

Mm-hmm. So, uh, it differs as well. You laid that out so clearly and nicely, Rick. It's, it seems at first when you hear about this, like, it's coming at you like information out of a fire hose. But we really appreciate you, like, doing your due diligence to, uh, to make it clear and nice and easy to understand for all of us who are not used to this.

Um-

Rick: What I'd say- Go ahead ... what I'd say, be careful of social media, okay? Stay off social media because that's what's causing a, a lot of fear and angst and all that because there are still some unknowns. You know, next week, you know, on or around July 1, CMS will release a proposed rule for 2027. That is the first time we will all see the total values that they are recommending for the 10 new codes.

So we know what the work relative value units are for the 10 codes. We can pretty well guess the malpractice RVUs will probably be .01 for each code. What we don't know is the practice expense RVUs, what is gonna be recommended by the RUC committee, and then what is CMS proposing? Are they proposing to accept RUC's recommendations of these RVUs, or will CMS propose different RVUs?

And we're gonna see that in the proposed rule, and then we can kind of determine, okay, in 2026, if these codes were in effect, what [00:16:30] would Medicare have paid for each CPT code? Now, obviously, I know, well, I think we have 78% of you do in pediatrics. You don't care about Medicare, but yes, you do. Because a lot of times Medicaid, TRICARE, commercial payers, they base their payment off what Medicare pays.

So I think we're gonna hopefully know, you know, hopefully the proposed rule comes out on time, uh, which is due out next Wednesday. Um, my hope is they get it out before the Friday, because Friday's a holiday. Um- Oh,

Kelly: yeah ...

Rick: then we'll know a lot more, at least what Medicare is doing. That would then give you the tools you need to start working with your commercial payers, state Medicaid programs, et cetera.

Casey: So we just need to get you back here on Wednesday then, huh, Rick, to do this again for us and break it all down. There you go. Thank you so much. So those are all the, the technical de- And this is final, right, Rick? How, how final is this? It's final?

Rick: It is final in that th- that 92507 is being deleted at the end- Okay

of the year. Now, of course, what we don't know is how soon in the new year will all your insurers have the new codes loaded and ready to go. You know, Medicare will be ready. Medicare is always ready. It's Medicaid, your Blue Crosses, your Aetnas, your Cignas, all those other payers. You know, are they gonna be ready come January 2nd, or might they not have the new codes loaded till January 22nd, February 22nd, March 17th?

Right. You know, I think that's gonna be the, the unknown per your [00:18:00] payers. Right. But it, it is coming.

Casey: It's coming. All right. Um, okay. So now that we know kind of the technical details, I'd love for us to talk more about, like, the impact that y'all are hearing already in the industry, um, and what everyone is really wondering about.

Stephanie, could you start us off, just as a clinic owner, what was your first reaction when you realized these changes could impact every speech therapy session in your organization?

Stephanie: Well, I'm pretty proactive, and the advocacy work that I do here in the state of Oklahoma has put me where I also am working with our MAU department at our state, um, Medicaid to determine, like, what is the next course.

So these conversations have been already initiated. My speech pathologists, whenever I contacted them about their knowledge about this, kind of looked to me. And as the leader of my organization, then that's my responsibility is kind of to eliminate fears and unnecessary concerns, because we still don't know what the final codes are gonna be.

We don't know what the reimbursement rates are. They know that I'm proactive in our industry and with, um, our state. Oklahoma also just recently went into managed care, and over the last two and a half years, that has been quite challenging. Mm-hmm. But we have an advisory group that we meet with [00:19:30] the executives of both the managed care entities and Oklahoma Healthcare Authority.

So I just went into action mode and started kind of with my list of, you know, what do I need to do? And one of them was to consider my clinicians and to kind of get them trained, talk about documentation, compliance. Um, think about authorizations, what, what does that look like? And that's why we're working with MAU at Oklahoma Healthcare Authority is to discuss, um, authorizations.

Currently they are ending all of our PAs December 31st- And we have meetings scheduled to try and get that changed so that we don't have chaos January 1st. Um, and so then, you know, started thinking about billing department delays in claim payments. You know, how is Prompt going to be managing this? I have zero concerns about that at all.

I feel like that's gonna be the easiest component. And, you know, then looking at the financial department on the reimbursement rates and how that's going to impact the clinic, and then start thinking about opportunities for silver linings.

Casey: Proactive versus reactive it sounds like is the key takeaway there, for sure.

And then just thinking about all the different areas of impact. That's-- I mean, what more can you do, exactly. So when you're talking to your clinicians with this clinical piece, what are the biggest concerns they are raising [00:21:00] when they first hear about these changes as you're visiting with them?

Stephanie: Probably just changes in documentation.

Um, we are relatively not-- I mean, we've been with Prompt for six or eight months now, but there's still things that they're getting used to. Um, they-- I think that they're just more worried about how much more documenting, and I'm like, "Well, you guys already document a lot." "Probably more than my other clinicians."

So I just try and kind of just say, like, "I understand that change is hard, but I-- most likely we are already doing the things that are necessary, whether they're reworded or put in a different order or a different number or just reformatted." I think they're okay with that. And again, they just kind of look to me to guide them.

And so as long as I'm reassuring that, "Guys, there's a piece of paper that fixes everything. We're gonna figure out all the words and paperwork that are needed to be able to do our jobs. And more importantly, how we help children, that's not changing, and could possibly improve. So again, let's look for the silver linings, but we're gonna be okay."

Casey: So true. I love, I love thinking about how your actual functional job is not going to change. You still are making the difference that you do every day with the kiddos. That's so important to remember. And [00:22:30] Nancy, what about on your end? What are you hearing, um, how do you feel like this could reshape peds practices in particular?

Nancy: What aren't I hearing? Well, for one, well, I just did an 11-city tour where I took Palooza around to 11 cities, so I probably had, um, somewhere around 300 pract- mm, maybe less, maybe 200 practices that I spoke to over the 11 cities. Um, one thing that I heard that's very interesting is that there are people that just threw it away, and not in a good way, not in a proactive way like, "We'll get through it," but in a way of, um, "I'm not worried about that.

I- I've never billed 30 minutes." But they don't understand the code is going away. Same thing, I believe, I may be speaking out of, out of, out of turn here as it's not my wheelhouse per se, but in Florida, they've never billed 30 minutes. So they're like, "Oh, no problem." But I, I think they need to relook at that.

But the bigger thing I heard, that was only a few clinics, a lot of fear, a lot of under their breath when I said, "Who's worried about, who's worried about 92507?" A lot of mumbling under the breath, terrified. And then the interesting thing, zero action. And, um, I have one gal that I, I just kept saying on my webinar, on my Lemonade webinar, "Action is the antidote.

Action is the antidote." Even if it's not the best right action first, you'll get there as long as you're willing to take action. The sit and wait, [00:24:00] the sitting duck, the deer in the headlights, this is not the way to go. The other thing is your CEOs, and it's like kids in a divorce are gonna be how the parents are.

If the parents are amicable and they're like, "Guys, families change. This is what happens. Mommy and Daddy aren't gonna be together. This is what it's gonna look like." Those kids are gonna fare better than if parents are crying and sobbing and screaming and yelling. Those kids, and I'm not here to compare people's staff as kids, but as the, as the face of the company or the head of the company and then those looking up to you, they're gonna be however you are.

And what I suggest is that you just remember that you're wearing a CEO hat and put it on very firmly because unfortunately, the universe is not doing this to you. It is not. But it feels that way 'cause with the diminishing reimbursements and things of that nature, the hiring desert, it feels that way. It feels like it's being done to you.

But really, business is business-ing. It's like your phone when it goes to voicemail doesn't think about answering the call. It's just wired to do that. Business is business-ing, economies are economy-ing, and change is changing, and change is not always comfortable. So my biggest thing is I'm hearing the fear and, um, action is the big thing.

So I guarantee you that in [00:25:30] September when I have Paloozaversary, there's going to be a lot of people that are less in fear and more in action that are gonna be willing to impart what we're gonna do and what the action plan is. And then I'm always bringing resources. So there will be resources coming down the road.

Look for them, look for them. Like Rick said, be careful with social media because I don't know if you know this, but not everything on social media is true. So if something is particularly fear-mongering, like you're gonna go out of business, it is not true. There are ways to find out other areas where you might be leaving money on the table.

You should find those out. You should find other holes. Right now is the time to strengthen everything you have to be prepared to deal with the change and everything. So that, that's what I'm hearing, and that's the way I respond to those concerns.

Casey: Yeah. Sounds like just change leadership is super important right now to help lead everyone through this change.

Um, and talking about resources I saw some questions come in about what resources are there. We've got Nancy, we've got Rick, we've got great... They've got great resources that we will be sending everyone at the end of this. You've got, um, your state license, you know, like association for speech therapy.

You've got the national ASHA, um, association who all have webinars about the intricacies of, of all the actual [00:27:00] technical details. You've got Fix SLP, if you're not a fan of ASHA, which I know is, is a, a theme these days. Um, and just doing your due diligence to follow along, like Nancy said, instead of just waving it away and being like, "Oh yeah, we've, we've got this."

That's the action right now, is to just stay informed, um, with what's going on. Another question that came through, which I think, um, Rick, if you would just reiterate for us. Reimbursement rates aren't set yet. When will clinics actually know the numbers? And how should they plan in the meantime? Um, 'cause I know you touched on this, but can you just reiterate the, uh, the dates?

Rick: Yeah. So right now, I would not plan to do anything right now. Uh- ... ideally, the proposed rule under Medicare will come out next week. Ideally, it'll be Wednesday or Thursday. Uh, at that time, we will see the proposed RVUs they are recommending for those 10 codes, so then we can kind of add up, get, you know, right, add up, up and get the total RVUs for each of the codes, and then kind of multiply it by this year's Medicare conversion factor and see, okay, what would Medicare have paid this year in 2026 for these codes?

As you think about 2027, you know, where do we think the conversion factor's gonna go next year? So we're gonna see the proposed conversion factor for 2027 in the [00:28:30] proposed rule. Obviously, it's gonna be lower in '27 than it was in '26, so we'll need Congress to pass legislation to increase that. So I think once you then see kind of, okay, in 2026, here's what Medicare would have paid, and we can run some, you know, numbers for next year.

I think you then take that and then start to w- you know, who are your top four, five, six payers that you're working with, you know, you start working with them. Now, obviously, if you've got payers that are paying you a per visit rate where you just get $60 per visit or $70 per visit, as long as your charges are above that, you know, I think here's a great chance to try to renegotiate that contract now because I think some of these RVUs, I think s- some of these CPT codes, I think the total RVUs are gonna be higher than 92507 is right now, and I think some, of course, will be lower.

And I'm gonna talk about this. I'm gonna talk about the base codes, the initial 30 minutes. I think a couple of those you could see them be higher than 92507. The higher, the better. So then I think it's then taking that and working with the insurances. Obviously, those insurers that pay you on a per CPT code basis, like perhaps a Medicaid program or a commercial payer, Medicaid, I would say to work, uh, work with your speech therapy state association because they may have contacts, you know, in the state government with Medicaid, and can they start to work with this?

On the national side, like it or not, you're gonna need ASHA to hopefully help you with the- Mm-hmm ... with the Aetnas, the [00:30:00] Cignas, UnitedHealthcare and so on. Um, now obviously, if you're with a big, big, uh, practice maybe in multiple states, maybe you've got contacts within CMS and things like that. But I definitely think once the Medicare numbers come out, you can run those numbers, and then I think j- analyze your practice right now.

You know, go look at the last six, seven, eight months of data. Talk to your SLPs. If you did 1,000 speech therapy visits- How many of those, if we had these new codes, how many of those thousand would have been speech sound production? How many of those would have been billed as speech sound and language comprehension expression?

How many would have been billed as fluency? You know, kind of do that, and then you can use the, the data, the numbers for this year and kind of see what that could do to your reimbursement, uh, from the other payers

Casey: Yeah. Those are all such good, uh, practical ways of being proactive, of taking these actions that we're talking about.

And all of those you can, you can start looking at the data now, and then after next week, you can start putting feelers out of who to talk to, of who to negotiate with, and maybe, like Stephanie mentioned, maybe there will be some silver lining to, to what these numbers turn out to be. Um, yeah. Stephanie, what's actually on your...

Like, I know you talked about kind of what you thought about first, all the different groups at your practice, the clinicians, billing, um, authorizations. What's, what else is [00:31:30] actually on your prep list right now before these numbers next week are final?

Stephanie: Well, and just as Rick was just saying is, you know, just initially identifying, um, when we look at our clients, what, what are the different categories?

What are the different areas that we're already treating kids, you know? Yeah, 92507 has been very combo with all these different elements. Let's break it down into exactly what we're doing and start looking at our goals and determining, is this something, do you have some voice that's been snuck in there with, you know, with a kiddo who's also just got regular language and artic?

Do we have some fluency that's already in there? These are looked- I look at this as an opportunity to now break all of our goals apart that speech and therapists have commonly just kind of all clumped together, and we may have a greater opportunity to serve our children in a better way. Um, where under the current model, we're just kind of forced to clump it all in there.

And due to reimbursements, we're kind of forced to just get it all done in the 30-minute session that, you know, do as much as what you possibly can. So really starting to have those conversations where we are breaking down those goals and reviewing them to determine what would they be if this was all separate.

They're fine with, with doing that, and taking that step back to kind of analyze that. The other thing is that we're considering looking at our report writing. [00:33:00] Do we need to change our evaluation report templates? Do we need to add different information in? Um, just kind of some of those little tweaks. And because our state has been in managed care, you know, just, uh, recently, we have already undergone lots and lots of changes.

And so as a change agent in my company, and with the advocacy group, then change is inevitable. How we navigate that change, then we have an opportunity then to direct the narrative instead of letting the narrative come to us. Again, the proactive versus reactive. So by looking at our codes- And our goals and kind of just currently analyzing it.

Um, looking at our report writing and determining changes in formats, templates, you know, um, so that we can be compliant. Um, waiting for these reimbursement rates to come in and determine the final impact, um, on whether or not we're gonna be changing production requirements. Production does not have to be a bad word.

It is our measure in which we impact our community and how it, it tells us how many children we are able to impact. And if we can help more children, then changing production is necessary. We could possibly have opportunities where we are helping children for a longer duration in our s- you know, in our sessions.

Instead of a 30-minute, maybe we can go to- Right ... a 45-minute. Wouldn't that be wonderful to finally actually get [00:34:30] reimbursed for that? And so, and again, that's kind of that silver lining, and where I look at is what are our opportunities. So that's also what I'm looking at. How many different options do we have to use these numbers to our advantage?

And how can we help as many children as we possibly can for even more so, you know, if that's an opportunity. Um, and again, I do work closely with our Oklahoma Healthcare Authority on how we're gonna be doing authorizations. And we have already, since our, you know, reimbursement rates for Medicaid come out July 1st in our state, we have already started having these conversations.

I highly recommend that therapy owners, if they do not have an advocacy group that works to communicate with your local state agencies, that they start opening up those lines of communication with other practice owners and to work together. And by contacting your local Medicaid offices, they want input.

They, they really do not want to have to make these decisions without having all the information. Many of them are not in pediatric therapy industry. They're nurses, they're doctors, they're from other disciplines. To have that kind of input, they have welcomed our information and to not always have to be the ones that maybe they have to make the final decisions, but the information that they're given in order to [00:36:00] make good decisions, when it comes where it's mindful of the children in your state that you're trying to serve, our administrators and executives have been very welcome to the information that we have been able to give them, and they are helping us help them.

And I feel like that kind of a partnership is valued, is important, and is needed

Casey: That is great to hear. And I think we sometimes lose sight of that, but it's great to hear that those associations are out there and that it's worth it to find them and join them and be the voice of advocacy for your own corner, in your own neck of the woods, um, for, for this particular issue especially.

Um, and I, I, so I heard the conversations with therapists, look at report writing, wait for the reimbursement rates. I also really loved what you said to think about scheduling. Like think about visit lengths. We haven't mentioned that yet, of just assessing how long are your visits now, um, who could benefit from longer visits that maybe before you were working with a tighter schedule and now you have this opportunity, um, to have these more involved sessions.

Um, and maybe that gives more time to go more in depth and to make more progress towards goals and, um, just ways that clients could use therapy, could use more therapy, um, that the current model didn't allow for. That was all, um, really good insight, [00:37:30] Stephanie.

Stephanie: We're really looking at our medically fragile children who have communication devices where a 30-minute session was just really a squeeze, and our state does not allow us to do the AAC, the 92...

What is it? 609 with 92507. They had to be separate visits. And so now being able to work with those children longer on those communication devices, and if they also, like for example, had like a passing mirror valve, so we're still do- even doing some things with voice. I mean, I have three kids right now with an eye gaze.

And so we- we're looking at this as an opportunity of like, oh my goodness, we're gonna get to help them so much more. We're really gonna get them to make progress at a faster rate by having more availability with them, and we are willing to adjust schedules and calendars to make this happen for them because the opportunities are there.

And if it comes with being able to have additional bill avail- billable units, great. Even

Casey: better. Exactly Um, Rick, anything you want to add, um, about this, the new codes, contacting insurers, making sure folks are ready, um, contacting CMS? Anything you want to add?

Rick: Yeah. I mean, CMS, I'll be honest, that's gonna be the easy one because once the proposed rule is released, it's open for a 60-day comment period.

So obviously, you know, ASHA will be submitting comments on behalf of their members. Uh, can [00:39:00] an individual SLP submit comments? Absolutely. Uh, you know, can Fix SLP on Facebook get together and do something? Absolutely. Can Prompt go, you know, look at all their SLP clients and put together something?

Absolutely. Uh, I'm sure ASHA will create a, a template, you know, letter that you can, you know, either just use or fine-tune and make it personal for yourself, your practice, and submit. So CMS is gonna be the easy one to, to comment on and all that, and CMS will be ready to go January, January 1 with the 10 new codes.

A- again, I think it's now taking that same logic and working with your state Medicaid, and then who are your other top three, four commercial payers? And if it's your state Blue Cross, you know, do you want to reach out yourself? Do you want to get to the, the s- your state's therapy association and do that?

You know, I, I think that's the key, and I do think you want to be proactive. You don't want to wait till the final rule for Medicare comes out in November because the codes are still coming. So you, you gotta make sure those payers are ready with the new codes. Uh, the unknown will be, will be the final payment because obviously things can change in November with the final rule, and then we also don't know what Congress will do with the Medicare, uh, conversion factor that does impact many state Medicaid programs, TRICARE, commercial payers.

Casey: I am also seeing a lot of questions. I'm wondering if you can clarify for us, Rick. Other speech therapy codes are, uh, not impacted. They still [00:40:30] exist. They're still there to use. It's just the 92507 that we're discussing that's gonna be replaced by the 10 new codes.

Rick: Correct. So 92508, which is the group code, that will stay.

So that's still gonna say, you know, treatment of speech, language, voice, communication, and/or auditory processing disorder, semicolon, group. That stays. You know, 92526, the, the feeding swallowing, that stays. Uh, the, and I've been answering requests about AAC evals. You know, those 92607 for the first hour, 92608 each additional 30 minutes, those two stay.

92609, the programming and modification of an AAC device, that stays. Now, if you now have the AAC device and now you're working with the client on treatment, instead of us having 92507, you know, what are you now working on with that client with the AAC device? Are you working on language comprehension expression?

If so, you're gonna go to that base code. Are you working on language comprehension and speech sound production? If so, you'll use that base code. So you are now gonna decide what are you working on with that client with the AAC device. Nice. Uh, one more if you don't mind. Yeah. Uh, you know, cognitive communication.

So cognitive communication will fall [00:42:00] under language comprehension and expression, whereby if you're working on cognition as it pertains to executive functioning, uh, memory, thinking, reasoning, compensatory strategies for, you know, organization, things like that, that's gonna be nine- still 97129 for the initial 15 minutes, 97130 each additional 30 minutes.

So I know we're gonna talk about this later. I'm doing a webinar in a couple weeks, and one of my slides is I'm encouraging all SLPs to send an email to CMS, 'cause here's your chance to get NCCI edits changed. 'Cause I'm sure right now- Mm ... you know SLP, you can't bill 92507 and the cognitive training codes the same day.

Well, here's your chance to bombard CMS to get that stupid edit removed because do I think, you know, SLPs work on language comprehension, expression, speech sound production? You could do that for 25, 30 minutes. But then can you do a separate 10, 12, 15, 18 minutes on cognition? So not kind of communication, cognition.

You know, memory, thinking, reasoning, planning, organization. Should you be able to bill that in addition to the speech therapy treatment codes? Absolutely. One of the dumbest edits I've ever seen CMS do, and I'm a PT and we've got dumb edits. Trust me, okay? Um, so, uh, I've been a PT for 35 years. I've gone through what you're going, gonna go through next year.

Uh, [00:43:30] so that's why I said you're gonna make it. You're gonna be okay. I, I, I get it, but I think you got a great chance to have some positive things come out of this and, uh, and we'll talk more about that later. Sorry. I'm kind of passionate- That's so great ... about SLPs. I'm a-

Casey: No, I love- ...

Rick: a broken

Casey: PT. It warms my little SLP heart to hear a PT talking s- so vehemently about, uh, our SLP rights over here, too.

So thank you, Rick. Um, and Nancy, before we go back, so we have another section where I'd love- we're gonna switch gears to how Prompt is prepared so that everyone can at least feel happy and safe and calm in the Prompt product environment, because we've got you covered. So we're gonna get to that so everyone will know all the things.

But I wanna hear from Nancy again. Just, I know you gave such great a- it's just so lovely to hear your advice. If you had one piece of advice of encouragement head- I know that we've heard it, but heading into this, like be- and I love, Rick, how you said, like, you've already gone through this. You're someone on the other side of this that we can look to at the light is the end of the tunnel of like you, you lived it, um, very similarly.

Nancy, what about you? What are you telling teams for encouragement and advice right now?

Nancy: Um, thank you. I love that question. Um, the number one thing that I'm- hell-bent on getting across is it's a really, look for opportunity [00:45:00] in every... To me, the way I have gotten through, um, baseball bats to the kneecap, as I like to call them- Yeah

uh, when life really hits you, and sometimes it hits people, you know, th- there are multiple things. They've got this going on. They get a 20% reduction in, in reimbursement in, in Georgia, and then they get 9257, and then a parent gets ill. It's just and, and, and. What I try to impart is that this is a profession that unfortunately, by its nature of the way you get paid, you're sort of at effect.

I like to say you're either the windshield or the bug, and I, there's like a spectrum. Be more of the windshield and be less of the bug. Easy to say. What do I mean by that? What I mean by that is there are things that you can do to be in control. I think there's always an opportunity, I'll also parlay on, on what Stephanie said.

I always think when life hits me with the baseball bat to the kneecap, there's always a lesson, a blessing, or a miracle. It's your job to find it out. Sometimes it doesn't happen till it's all over, and you get to come up for air. There's a lesson, a blessing, or a miracle. Use this to springboard because there is housekeeping you can do.

And what I mean by housekeeping is there are people out there that don't know their numbers at all. They're very much driving practices in the dark. It's not a good way to [00:46:30] operate because you're gonna feel super overwhelmed. So if that's you, you need to take action on that. If you are thinking, if you've been thinking, "I need to switch EMRs," now is the time.

You're, m- guys, go look and see what's out there. I love Prompt for a lot of reasons. I'm not a clinic owner, have no fancy letters, but I liked Prompt for the product that it is and what it delivers and how they, they work with the pediatric field. So, but go do your due diligence and look, and if now's the time, take a look.

Get a demo with Prompt. Do it because now is the time. So you have homework to do. You have housekeeping to do. Um, this is a good time. If you fear, I always say expect the best, prepare for the worst, that you're not gonna get paid in January, become very super aggressive with your accounts receivables from now until December 31st.

Get that money in. Look at your front desk. See if you're leaving 50, 100, $150,000 a girl t- a month ago, an owner a month ago. People are leaving money all over. You can soften the blow. You can, if there is a blow, you can soften your fear of the blow. I know there's a fear of the blow, so let's just combat that.

Find your locus of control. So what I mean by being at effect in this business is that where else... If I go buy a piece of pizza, I pay $5, I get a piece of pizza. Where else do you deliver all of [00:48:00] this and then they decide, "Well, maybe the kid didn't really need the pizza," or, "Maybe the pizza isn't really worth $5, maybe it's worth $3."

So you're already kind of, like, set up to be a little bit more the bug than the windshield. So your job is to combat that, look at it like a game, and you have to prepare. What do NFL football players do? Do they just, like, sit and wait for the game to happen and get on the field? No. They prepare for weeks, months, day in, day out, and it's very strenuous.

So take it on like a game and get in the game head that there are things you need to do, and the first one is look at your locus of control. What you can control. Can you control getting your accounts receivables in better? Can you control how your staff handle things? Can you handle production a little bit more efficiently?

Sure. These are all things to do. So that would be my advice. And of course, always in there, like I said, always breathe. Always breathe. And think about the outcome you want, how you want this to be for you. And talk with other owners and get with owners, get in spaces where other owners that know a little bit more than you can impart their wisdom.

Casey: Thank you, Nancy. I could listen to you talk all day. Okay, um, but I won't. I'm gonna let us move on now to another fun part with Kelly, our Prompt product expert person, who we love so much, and she is going to give us a little preview of [00:49:30] how Prompt is preparing. Before we do that, um, one more, another poll right now.

Um, which of the following concerns you most about this transition? You'll have a few options, and I'll share my screen for the slide deck, um, and that way we can know what to address and speak on the most here for Kelly.

Kelly: While we're waiting for that to come in, Casey, I did want to just make one comment. Um, like Rick, I am also a physical therapist, and so I, um, can feel the pain of everybody here. Um, but I also-- One thing that we do on our side in the PT world and, um, is we really talk about how a lot of the CPT codes and how they're set up help us prove value of what we do.

And so I think that for SLPs, this is an opportunity to do the same, where you guys have an opportunity now to, um, really show the value of what you're doing with your patients day in, day out, and, um, more clearly define it both from a code, so as a, you know, the code representing what you're doing, but then also from a documentation standpoint.

So, um, I get passionate about those things, um, even though documentation is not that exciting. Um, but I do think that seeing that as a opportunity is great

Casey: Okay. Our biggest concern, Kelly, is potential reimbursement changes.

Kelly: Okay.

Casey: And then next is documentation requirements, which I totally get. Um, understanding the new codes, [00:51:00] whether our EMR is prepared.

Oh, good. Not everyone is super concerned about that. Maybe they all- Yeah ... know and love Prompt already. And then compliance and audit risk. Okay, Kelly. So we were-- Kelly and I were kind of discussing the other day too, a few practical moves to be proactive, and these you can do inside of Prompt. Um, except I put lean on our resources at the end.

We're gonna give you some great resources from Rick and Nancy too. But, um, but Kelly, do you wanna speak to what they could do now to p- be proactive inside Prompt and then show what's coming?

Kelly: Yeah, absolutely. So, um, just quickly, you know, you can obviously read the slides here, but one thing to do, um, and as Stephanie and Nancy and Rick have all kind of discussed, is making sure you can, like, map your top diagnoses, understand how long are your current scheduled appointments, um, all of those things you can obviously see with-- from within Prompt today.

You can also practice on real scenarios. So this is where, you know, Casey and I talked a lot about this, of like, okay, I see this patient, here's how I bill today, but here's what I could do in the future. Um, and then you can map that out. When we get the reimbursement codes next week, then we'll be able to see what potentially we could be reimbursed in twenty twenty-seven for.

So then we can start to understand what do we need to shift in our organization, how do we need to shift schedules if we do, et cetera, et cetera. Um, again, the revisit your visit length, so that's something to, to think about. Is there opportunity to treat these kiddos that need to be treated for a longer period of time?

Can we now do that and get reimbursed for it? Um, and then as Casey said, leaning on the resources. So we'll have a lot of resources [00:52:30] for you, obviously from here, but then, um, you know, as Rick mentioned and everyone else has mentioned, all of the resources that you have in your state and in your, um, nationwide too.

Now as we go into the how Prompt is going to help you. So th- there's three kind of aspects that I really want you, this group to think about. There is how the EMR will help you, so in the actual documentation. And then we have, and what my specialty is, is the AI portion of this, which is our Sidekick, which is our scribing tool, and Insight, which is our analytics tool, which is our AI analytics tool.

So we'll talk a little bit about all three of these today. Within the Prompt EMR, one thing that I want you to think about Is that we have been serving PT and OTs who have, as Rick mentioned, a similar way to bill for many, many years. So we've been doing that for many years. In fact, I talked to our products team and, and I probably should have started it this way, but one thing to let everybody know is that we are very actively working on all of these improvements today.

So we are planning all these improvements out. We have this all organized. I talked to our head product guy who's leading the charge on this, and I said, "How's this gonna go?" And he's like, "Oh yeah, the- we've got this totally figured out. Like, this is gonna be totally piece of cake. So on January 1, we'll be able to flip this over, and it'll be there for all of our SOPs."

So they're very confident in that. I'm very confident in that because we have been able to serve our PTs and OTs with similar fashion. However, of course, taking into consideration some of the things that might be a little different there. So that's something to keep in mind Additionally here on this slide you'll see...

Oh, sorry, Casey, anything else to [00:54:00] add there?

Casey: Oh, no, I was just agreeing and saying, um, everything is vis- once-- I was just looking at this. Yes, billing calculates itself automatically at checkout, and also as you're treating, you see all the calculations as you go. So it's really visible.

Kelly: And that's where, like, the, the big change for the SLPs is gonna be, you know, how do I pay attention to minutes, and how many minutes did I do, and things.

And that'll take some adjustment, but then documenting it in the actual EMR, that's where we've been doing that. It will calculate itself. You don't have to add up all the minutes. Funny enough, um, with other EMRs I've worked with in the past, um, that's been a thing that's not there, and so Prompt will do that for you, which is obvious that of course we should help with that.

Um, so that's something that we'll be ready to switch on exactly when we get into, um, January 1st. When we get into the next slide here, this is where we can start to see, like, the different ways in which we are actually documenting the codes. And so today, with everything kind of sc-scrunched into one, um, we're just seeing a single thirty-minute entry, one paragraph, and it doesn't map to any one specific code except this kind of, like, code that encompasses everything.

Now we'll be able to, which Prompt already, um, does for PTs, OTs, we'll be able to actually use different treatment cards for those of you who are familiar with that term. We'll use different treatment cards to actually support and put the supporting documentation for those particular, um, codes. Now, that might sound like more documentation.

We'll talk about a little bit of how we can help with that in a, in, in the next slide or two. But [00:55:30] just keep in mind that this is a way in which we can actually document what we're doing to prove value for what we do for our, for our patients. Um, and then already in Prompt, you'll see on that slide, um, that it already does calculate that for you.

So that's something that already exists today. We'll just now make sure our SLPs are familiar with that and that they can use that. In the next slide, this is where we start talking about, um, Sidekick for SLPs. So Sidekick is our AI scribing tool. So within our PT and OT realm, we do have scribing, and we have CPT code assistance, where it helps you understand if you have the appropriate coding for the justification that you wrote.

And so we are in the works, which is, um, I will say, you know, we are little bees busy behind the scenes here, making sure that we're getting everything ready so that we can provide the same amount of insight for our pr- our SLPs when they're using Sidekick, as well as our PTs and our OTs. You'll also see an example down below there that Casey so beautifully put together, um, as a way that you can imagine Sidekick helping you when you might be using two of those specific codes and ensuring that you have the justification for both of those codes.

Um, so again, not only does Sidekick help improve your, um, timing, so it reduces the documentation burden, but it also helps you ensure that you're correct- selecting the correct code and also have the justification. And then the final portion, as I mentioned... Oh, go ahead, Casey.

Casey: Oh, I was just gonna say the only thing you have to do with Sidekick is review it.

Like, [00:57:00] truly it's magical. Yes. You go in and you see your patient and you say all the things. It puts all the things in the right places, gives you suggestions for coding. Um, so you're just reviewing and making that last final, like, yes or edit and however you, you wanna fix things to, um, to what you think.

But really it's the most magical tool for the actual documentation for clinicians that you could imagine.

Kelly: And, and for those of you who are a little hesitant about AI, I'll just reemphasize what Casey said, is that everything we design with Prompt that has an AI function to it, we require there to be clinician, um, like acceptance or attestation that it is true.

So I'll just reemphasize that what Casey said, that you have to review it and push it into the note. However, the quality is very good, um, because we work very hard on it. Um, okay, so then that third kind of bucket I was talking about, so we have our actual EMR, we have our Sidekick, and then here is our analytics portion of this.

And so this is where we actually have an AI tool built into our analytics that helps with two main things. Now, there's, and I should say main things, there is an enormous amount of information that we are able to give people access to in our insight product. I'm going to highlight two that is specific to this code.

One being that we are ensuring that the appropriate documentation is there for compliance, and we can highlight therapists or specific notes where that might not be happening. So that's one thing we will do. The second thing we'll do is actually analyze how the therapists are utilizing the code. So this will get you a retrospective [00:58:30] analysis on like, okay, this one particular therapist, Casey, is having trouble diversifying her codes in order to utilize her time the best when she's with her kiddos.

And so that's one thing that we can actually help our clients see. We can see patterns. We can see how these clinicians are spending their times with their patients so that you as a practice owner can ensure that all the hard work that you're preparing for now and that you're priming your therapist for is actually working, and that they understand it, and that there's not gaps that you need to hit

Casey: Okay. That was awesome. I also just want to shout out one more thing is everything is also beautiful, so it's easy to see. It's red, yellow, and green for, like, not good, slow down, go ahead. And we've, what we've seen from big teams using Insight is, like, the biggest thing that stands out to me with the data is the improvement over time, everyone's compliance getting better and better as they're using these tools, Sidekick and Insight, and knowing that, like, all the coding and the documenting and the justification is there, and then you feel so audit proof.

You feel so secure in what you're doing, and you really learn as a therapist, and I just wish those tools had been there when I was treating as well. So we've all been talking about resources today. I know only we have one minute left. Please next go to Rick's webinar, which will be even more in-depth.

First look at the new speech therapy CPT codes at gowindaseminars.com. You can scan this QR code to take you right there. Um, we'll be sending out this information afterwards as well. And please also attend [01:00:00] Nancy's Peds-A-Palooza, uh, versary twenty twenty-six, Lake Las Vegas, Nevada, September twenty-fifth through twenty-seventh.

Just head to pedspalooza.com/paloozaversary2026 or scan this QR code. Just want to say thank you again to all of our guests, um, for your wealth of information. Just it was lovely to sit and hear all of your experience and all of the little gold nuggets you shared today. Um, you are really making an impact.

And thank you everyone for joining. Y'all took the first step of being proactive by attending this webinar, so truly you're doing-- you're on the right track already. The fact that you're here, just keep, um, being proactive. Keep reaching out to resources. We are all here for you. Prompt is here for you, and we wish you all the luck in the world.

So everyone have a great, uh, rest of your week, and we'll talk to you all soon.

Nancy: Thank you. Thank you.

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