Could Prestige’s New Policy Reduce Your Fees?
Like some of you, I was having a great start to my 4th of July weekend, then disaster struck!
One of my wonderful clients sent over a fax they had just received from Prestige Health Choice outlining a new policy for Multiple Therapies on the same day.
I read through it and my heart sank. “That can’t be right!” I said to myself. I read it again. It still wasn’t clear and sounded like Prestige was going to begin reducing some payments by 30%!!!!
What does that mean in terms of real impacts? If, for example, you perform 1 hour of Speech Therapy at 100% of the Medicaid rate, you should be reimbursed $71.44. This policy appeared to state that if you perform ST and OT on the same day, one of those services will be reduced by 30% so that you would only be reimbursed $50.00 for 1 hour of treatment. Unbelievable! That’s not even enough to pay most therapists let alone, admin, rent, utilities, and any profit for the business.
This new policy would be a huge issue for providers who offer multiple services at the same location. I’m sure you can imagine the impacts of this policy on patient care, scheduling, and business profitability, etc.
Take a look at the full policy below.
Prestige Health Choice:
Therapy Reduction Policy Screenshot
I reached out to the Prestige Provider Rep team right away to get clarification on this new policy.
Initially they confirmed my worst fears that different therapies performed on the same date of service will be reduced. We went back and forth and I informed them that this would be a huge contractual issue because they shouldn’t be able to change rates without negotiation.
At this point, tensions were high. Providers were distraught thinking about all the new schedule changes and how some patients may just stop coming to therapy altogether. Then…breakthrough.
Prestige added a bit of crucial clarification to their new policy.
There would only be a fee reduction IF the service was performed by the same individual provider; not the same provider group. So, in order to get hit with this fee reduction, a licensed SLP would also have to be a licensed OT or PT AND perform two services on the same day. I’m sure they exist but I’ve never known a therapist who was licensed in two or more disciplines and practiced both. Hopefully, this policy will have no effect on your practices.
Crisis averted; for now.
As a community, we need to be on the lookout for these types of policies that negatively impact patient care. We are not alone in fighting back against these types of tactics and we are stronger together.
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