EPISODE 257

[0:00:00] MD: Okay, so for today's gratitude entry, I am grateful for attending NBASLH this past April. Y'all, I met so many amazing, amazing phenomenal souls that are just, they truly want to pour good into this world. Today's guest, Lauren Hastings, is one of those amazing colleagues that is truly giving so freely of her time on so many different fronts. I am grateful for NBASLH 2023 and looking forward to NBASLH 2024, of which Lauren is one of the convention co-chairs. I'm plugging it right now.

Y'all, please come April 11th through 13th, 2024 for The Essence of NBASLH in Raleigh, North Carolina. I would love to see you there. Thank you NBASLH and Lauren, thank you to you and your convention co-chair. I can't wait to see this year's. Yay. All right, enjoy y'all.

[INTRODUCTION]

[0:01:22] MD: Hi, folks, and welcome to First Bite: Fed, Fun and Functional. A speech therapy podcast sponsored by speechtherapypd.com. I am your host on this nerd venture, Michelle Dawson, MS, CCC-SLP, CLC, the All-Things PFDs SLP. I am a colleague in the trenches of home health, early intervention right there with you. I run my own private practice, Heartwood Speech Therapy here in Columbia, South Carolina. I guest lecture nationwide on best practices for early intervention for the medically complex children. First BiteÕs mission is short and sweet, to bring the light, hope, knowledge and joy to the pediatric clinician, parent, or advocate.

[0:02:09] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:02:13] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:02:18] EF: Ethics on how to run a private practice.

[0:02:21] MD: Pediatric dysphagia to clinical supervision.

[0:02:24] EF: And all other topics in the world of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts.

[0:02:33] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[0:02:39] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:02:42] MD: By bringing other professionals and experts in our field together, we hope to spark advocacy, joy and passion for continuing to grow and advance care for our little ones.

[0:02:53] EF: Every fourth episode, I join them. I'm Erin Forward, MSP, CCC-SLP, the Yankee by way of Rochester New York transplant who actually inspired this journey. I bring a different perspective, that of a new-ish clinician with experience in early intervention, pediatric acute care and non-profit pediatric outpatient settings.

[0:03:14] MD: Sit back, relax and watch out for all hearth growth and enjoy this geeky gig brought to you by speechtherapypd.com.

[DISCLOSURE]

[0:03:29] MD: Hey, this is Michelle Dawson, and I need to update my disclosure statements. My non-financial disclosures. I actively volunteer with Feeding Matters, National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP, a past president of the South Carolina Speech Language and Hearing Association, SCSHA, a current Board of Trustees member with the Communication Disorders Foundation of Virginia. I am a current member of ASHA, ASHA SIG13, SCSHA, the Speech-Language-Hearing Association of Virginia, SHAV, a member of the National Black Speech Language Hearing Association in NBASLH, and Dysphagia Research Society, DRS.

Additionally, I volunteer with ASHA as the topic chair for the Pediatric Feeding Disorder Planning Committee for the ASHA 2023 Convention in Boston, and I hope you make it out there.

My financial disclosures include receiving compensation for First Bite Podcast from speechtherapypd.com, as well as from additional webinars and for webinars associated with Understanding Dysphagia, which is also a podcast with speechtherapypd.com. I currently receive a salary from the University of South Carolina in my work as adjunct professor and student services coordinator, and I receive royalties from the sale of my book, Chasing the Swallow: Truth, Science and Hope for Pediatric Feeding and Swallowing Disorders, as well as compensation for the CEUs associated with it from speechtherapypd.com. Those are my current disclosure statements. Thanks, guys.

[0:05:26] EF: The views and opinions expressed in today's podcast do not reflect the organizations associated with the speakers and are their views and opinions solely.

[INTERVIEW]

[0:05:34] MD: Okay, everybody, I am tickled pink that we have today's guest. We have none other than Lauren Hastings. If you don't know her, oh my goodness, by the end of this hour, you will know her, and then you will know why I'm so stupid, giddy, excited that she's coming on. I met Lauren, I think, in person, officially at NBASLH. I feel like we had known each other through overlap.

[0:06:00] LH: I met you at a booth at ASHA. I played it. I have the video on Ð I should send it to you. I have the video on my phone where I was rolling the dice. You remember that?

[0:06:11] MD: Yes. On SpeechTherapyPD. It was their booth.

[0:06:16] LH: No. Orlando. I think it was Orlando.

[0:06:18] MD: Okay. Okay.

[0:06:19] LH: It might be Orlando.

[0:06:22] MD: Yes. Oh, I'm thinking that that's been a minute, [inaudible 0:06:26]. Yes. But yes. Her and I really got to know each other at NBASLH in DC this past April for the Ð is it the 45th anniversary?

[0:06:38] LH: Yes. Mm-hmm.

[0:06:39] MD: Yes, 45th anniversary. Y'all, I love her. Her energy is just Ð I used to say infectious, but post-COVID, you can't say infectious. But it's exuberant, because it's just Ð there's people that walk in a room and they just light it up from within. You want to be around that, and that's you.

Okay, so now let me tell you the amazing things that this woman does. Her craft, her specialty, or her Monday through Friday, is helping other women set up their own private practices, and men. We'll include the men folk, too.

[0:07:18] LH: Often, I do.

[0:07:21] MD: Yes.

[0:07:22] LH: And some OTs in there, too.

[0:07:27] MD: She helps us on that leap of faith when we want to get credentialed, when we want to battle insurances, when you are ready to step out and do it on your own, which can be one of the scariest, most vulnerable moments. However, she also pays it forward. She ties with her time. This coming 2024, she is the NBASLH Convention co-chair, or no, chair in 2024.

[0:07:53] LH: Yeah, convention co-chair.

[0:07:55] MD: Convention co-chair. It is in Winston-Salem, I think Ð

[0:08:00] LH: Raleighm. Raleigh. Raleighm. That was Ð two words. Raleigh, North Carolina.

[0:08:06] MD: Raleigh. I mean, sorry, North Carolina. I haven't back and afraid to go in my office, but in Raleigh, North Carolina. Also, she served on the topic committee for language disorders in the infant toddler preschool age for ASH Convention for 2023, as well as is a coordinating Ð she's on the coordinating committee for SIG-1. I don't really know what SIG-1 coordinates.

[0:08:37] LH: It is language learning and education. It was very broad. We're actually the second, or third largest SIG.

[0:08:46] MD: Wow. Awesome. Yeah. I know SIG13 and SIG12. SIG12 is AAC. SIG13 is dysphagia. I still think they should divide SIG13 from dysphagia to PFD, and we should have a whole separate SIG for PFD, because it's so different from dysphagia. Add that to the dream to-do list for 2024, because 23 is, you can put no extra big ideas on it. But y'all, she is amazing and she is phenomenal. Oh, oh, my God. And you co-host Spill the Tea with the other Lauren.

[0:09:18] LH: Yes. ItÕs called Speech Tea.

[0:09:24] MD: Oh, man. I got so excited.

[0:09:27] LH: You did. You were close enough. Yes, Speech Tea podcast with the Laurens. We are on the road of almost celebrating our 50th episode. We are up to, oh, I don't know, 3,000 or 4,000 downloads, I think. Something like that. We're turning three in August.

[0:09:51] MD: Yay.

[0:09:54] LH: We came up with it during COVID. We just took our conversations that we normally have and disagreements to the airways. Yeah.

[0:10:04] MD: That's beautiful. See, there's good things that came out of COVID. We just have to choose to focus on the joy. That's my thought process. Yes. Okay. As with all things, take me from the beginning. What made you want to be a speech pathologist?

[0:10:24] LH: Ooh. I'm one of those rare people that knew since high school. In high school, I taught myself sign language and I used to sign to music at church and school.

[0:10:35] MD: Awesome.

[0:10:36] LH: No shade to the interpreters, and now I regret it. I was like, ÒWell, I just don't want to just be an interpreter.Ó Now, it just hit me why I said that. I was raised in a single-parent home. When youÕre raised in a single-parent home is all about getting an education degree and make money so you can be better than what we are, right? I was raised by my mother and her two sisters. They did not finish college. Being a sign language interpreter wouldn't have held up in my household.

I went to a college fair. You know how they do when you're in high school with those college fairs, they're like, ÒOh, what's your hobbies? What's your whatever, whatever?Ó I actually was at a college fair where Long Melinda University was at. I walked up to the table and I told her that I love sign language and she was like, ÒYou should look into speech language pathology.Ó I was like, ÒWhat's that?Ó ItÕs a course. Let's be honest, as a black person in the south, you don't hear about that field. She told me about it, gave me the pamphlet for the major. I went home and I read it and I was like, ÒThis is what I'm going to do.Ó

I just followed that and got my undergrad in speech-language pathology and audiology at Andrews University. Then I went on to Tennessee State University and got my master's. I know most people they hear stories about like, ÒOh, I started in this profession and switched over.Ó I literally knew since my senior year in high school, that is what I wanted to do. That's how I got into it.

[0:12:19] MD: Well, my youngest brother was born with a cleft lip, not a palette. It was just a lip. then my step mom got electrocuted when she was pregnant. Seven months pregnant, she was changing the flippity part of the light switch. I don't know what that flippity part is called, but you know what I mean. What is that? Is that circumlocution? Is that the strategy that they talk about for aphasia? You just, whatever. Anyways.

[0:12:48] LH: I see that [inaudible 0:12:49].

[0:12:55] MD: She got electrocuted. Then he was born with dysarthria, because of [inaudible 0:13:00]. He didn't talk until he was four. He went to a speech therapist and it wasn't apraxia. It was dysarthria. I was 12, 13. I knew. I knew that's what I wanted to do. Then I saw my very first wall of study in undergrad and was like, ÒThat is what I want to do.Ó Then I got out and graduated and was like, ÒOh, I don't actually necessarily want to work in a hospital doing that, but I want to do that.Ó Also, adult boogers are really gross and very large, so I didn't want to work with the adults, especially when itÕs like, action and change things. Also, my grandparents helped raise me, so I would hug all the old people. This is frowned upon in the professional setting. You can't booger hug everybody. Pedes feeding, man. It went Ð 

[0:13:47] LH: Yeah. I mean, and I have a similar story when it comes to going into pedes, because, unfortunately, I've experienced a lot of death in my family. For me, being around older people was just like, a Òno.Ó I used to get internally upset when I saw my friends disrespect their grandparents, because I'm like, ÒYou have them. I don't.Ó Ooh, I prayed my way through my medical Ð because I was at a school of nursing facility in my prayer. IÕll never forget, my first day, I pulled in the parking lot and I said, ÒGod, I know death might happen. I just need it not to happen when I'm here. That's all I ask is that if any of my patients die, I don't need to be here.Ó Literally, the few that I had passed away either passed away that evening, or passed away on the weekend.

[0:14:48] MD: Grace.

[0:14:50] LH: I was paired with a perfect person, because she left the school system because she had struggles getting pregnant. She never had kids. She went in and worked with adults. Then my story about not wanting to be with adults, because of not only my own grandparents, but people, I consider my adoptive grandparents have been sick and going through strokes. You want to hug on them? I get mad when they don't get visitors, right? Because whatever, I just Ð and again, my experience, I feel like, regardless if they are alive, you need to go visit your relatives. That's just how I feel.

We helped each other, because the facility wanted to do some outpatient and she started getting a few kids. At first, she was like, ÒI can't do it.Ó Just through our connection, the few months, she felt empowered that she could start seeing kids, because I wasn't going to be there forever. We literally got a kid a month before I left. It was just like, ÒYou got to do this, sis.Ó Do what, you need to pray together. What can we do? But I made her feel like, ÒListen, if I can power through this, right?Ó Because yes, I saw people in my life who had either passed away, or had illnesses in my patients.Ó

I told her. I was like, ÒIf I can power through this, you can too.Ó I still, to your point, adults, I was tired of walking in the room and explaining while I was there, explaining my profession. I was like, ÒI can't do this every day,Ó because they will hear speech and they're like, ÒI don't need speech.Ó I'm just like, ÒHow can y'all do this every day? I can't. I can't. I can't.Ó

Then I didn't like Ð now I'm about to go to my passion with insurance and stuff. Now that I know what I know, I really hated that PT got more business than we did. That really like, can I say piss me off? That really turned my ears. Now that I know more about insurance, I'm just like, why is it that the government Ð because this is a government thing, because they're separate from us, right? When it comes to insurance, everyone has their own. Well, I take it back. No, no, no, no, no. We have our own, but I think PT Ð is it PT and OT share, or is it OT Ð

[0:17:23] MD: Share.

[0:17:24] LH: - and SLP share? I think PT and OT share.

[0:17:25] MD: PT and OT share.

[0:17:27] LH: But they have more money. They have more money. I will never forget, it was his guy, he couldn't even tell you his room number, but he was over there doing his look, up and down, walking steps, exercises with the PT. I'm just like, and we only get him for four weeks, but they get him for three months. I mean, and it's so crazy, because now when I see the emails from ASHA about Medicare, I'm like, ÒThat's why I ain't working with adults.Ó

[0:18:05] MD: No, this is why I didn't want to credential myself or deal with the insurance when I had my private practice, because I would stay angry. God gave me, oh, my Lord, my family has a deep righteous anger. We can get our IRA up. I mean, I will run so hot, I will literally flush if I don't check it, right? I'm doing it now. I can feel the temperature in my cheeks rising, but that's Ð oh, but I couldn't be there doing it while Ð because when I set up Heartwood, which honestly, it's really cool. It's our family tree. Our family tree, our family was my tattoo. I used my tattoo for my private practice logo, which nobody knew. It was just, whatever. I thought that was really cool. I put more hearts in it. Anyway.

[0:19:01] LH: Michelle, this is why I love you. I think I have crazy stories. I think you might have me beat.

[0:19:11] MD: Also, that was Ð

[0:19:14] LH: You really did? You had a tattoo?

[0:19:16] MD: Well, they did after I got divorced. Okay, so my ex-husband was very violent and beat the hell out of me. I'm alive, because I took the bullets out of the gun one night, or I would not be here. I always use that in my testimony, because I love Jesus and I cuss like a sailor, and those are my unofficial disclosure statements. I got so hot, I had to take my sweater off. In the process of going through my divorce and before I met my husband, there was a really great Irish bartender, and he was really good friends with the tattoo guy. That's how I got the tattoo. Then a few years later, turned it into a business logo. Guys, that might not be the best business strategy, but worked for me.

[0:20:03] LH: Worked for you.

[0:20:04] MD: Worked for me.

[0:20:05] LH: IÕm going to have to go look up your logo. That is what [inaudible 0:20:07].

[0:20:09] MD: After recording, I will show. I have my microphone off screen. I figured, she's no idea why I'm looking this way. Yeah, I'll have to Ð

[0:20:16] LH: Oh, you got the Ð But I got the same one.

[0:20:19] MD: WeÕve got the same Ð we're microphone sisters. Y'all, the microphone has an interesting shape. When I first pulled it out of a box, my husband looked at me and he said, ÒShould I have concerns?Ó

[0:20:30] LH: Flip it up and down?

[0:20:34] MD: Yes. Oh, my God.

[0:20:36] LH: YÕall supposed to get ASHA CEUs after this. Okay, letÕs be Ð

[0:20:39] MD: Yes. I was going to say, I just need y'all to hurry up now and sign up for an NBASLH 2024, because it's three days of this and it's amazing. Okay. Anyways, where were we? Credentialing? I don't know. No, IRA. See, I chased my noodle all the way back. I would get so frustrated when I was independent contracting for these other women with Ð they were like, ÒOh, you can't code this. You can't do this.Ó Don't tell me how to code, because what I'm coding are two different CPT codes. I can't code feeding and swallowing under 92507, because that's not. That's language. 92526 is feeding and swallowing.

However, in South Carolina, the reimbursement rates were less. They were paying me the same rate, and I was making less money. I'm like, but what you're asking me to do is compromise my code of ethics and my license and I will do this not.

[0:21:34] LH: Let me tell you. Let me add to that though. You can bill them together. The problem is, you get less visits, at least with straight Medicaid. In Georgia, straight Medicaid allows eight visits a month. If I bill 92507, and I don't know it as quick as you, but the feeding and swallowing code, if I bill it together, they consider that two visits, even though Ð

[0:22:00] MD: But it's not. It's one visit.

[0:22:02] LH: But you get paid more.

[0:22:03] MD: Exercising the top of your license. Okay. Well, then we'd be screwed, because I would add in AAC, and be working on Ð I would, because my babies need all the things, right? That's why you call me. Long story short, I got done and fed up with being told what I couldn't do, what they didn't want me to do.

[0:22:22] LH: They explain to you why though?

[0:22:26] MD: Oh, no. Because Ð

[0:22:27] LH: They party and you know why.

[0:22:29] MD: You just hit the nail in the head, ma'am. Anywho Ð

[0:22:32] LH: They just probably know we get paid less. But I'm really big on people understanding why.

[0:22:39] MD: Yes.

[0:22:40] LH: So, yeah.

[0:22:42] MD: But they could not. What I did was I reached out to Andy Larry, who's the South Carolina, or was at the time, star representative. She just retired.

[0:22:51] LH: Okay.

[0:22:53] MD: From practicing and stepping down from that. Okay, folks, if you are listening, this is where we're going to put in a call for action, okay? Because we're all about that. If you are upset about your reimbursement rate, you cannot go on social media and vent that ASHA is not doing more to get your reimbursement rate addressed, because it is not ASHA's responsibility at the state level. It is your state association's responsibility to advocate at a state level. ASHA can advocate at a federal level. However, states versus federal rights is a whole communication Ð

[0:23:37] LH: Can I slither into that statement?

[0:23:38] MD: Yes. Come in. Come in.

[0:23:41] LH: To add to that, every state has their own budget, has their own allotment. Just like, should I throw out numbers?

[0:23:52] MD: Yes.

[0:23:53] LH: Should I throw out numbers? Like In Georgia, I would be transparent and say, our reimbursement rate is $60, but I know in South Carolina, 92507, I think it's $90, right?

[0:24:04] MD: 9925.

[0:24:05] LH: Missouri is $25.

[0:24:08] MD: What? How do you make a living?

[0:24:11] LH: I don't even remember her name, so it's probably a blessing, but it was someone who signed up for a coaching call with me. Actually, it was she and her husband, because her husband was going to do the bill. They were asking me, because I always tell people when they talk to me, I always ask them, ÒDo you know your Medicaid rate?Ó Because that is really your guiding light when you're setting your rates, in my opinion. Because all the insurances align with the Medicaid rate. It's important for you to find out what your Medicaid rate is for your state.

Yeah, when she said to me, I said, ÒIs that with modifiers?Ó Was like, ÒAre you sure?Ó She was like, and I googled it while we were on the phone and sure enough, I'd saw $25, $27. To Michelle's point, because someone tagged me into something recently, I think it was Ohio, because I think theirs was $30. They did the right thing. They went through their state association, but their state association wasn't really helping move the dial. They have come together as a group, and they're going to go to the state themselves.

Like Michelle said, let me tell you, every state and Michelle can correct me since she was president of South Carolina for a minute. I know for Georgia, they pay a lobbyist. They have people who go on our behalf to try to get an increase, because we try to get an increase. But our lovely governor, it literally, everybody said, ÒYes, yes, yes, yes, yes.Ó Got to the governor, he shut it down, because we want a pay increase. I mean, $60 is good, but $70, $75 will be great, or more. Yeah. Go to your state association first.

I will also add, too, if you have questions about anything, especially about codes, reimbursement@asha.org. I have the lovely pleasure of sitting on the healthcare committee meeting right before ASHA began that Wednesday, before ASHA started, this past year in New Orleans. I didn't know what I was getting myself into, but then I felt like, I was blessed to be the chosen one, because I was next to one of the people that work at ASHA, who helps write CPT codes. I was like, ÒOkay. Jesus, I don't know what youÕre doing, but I'm here for it.Ó It was her. I even forgot her name, but we were sitting there Ð

Oh, side note, Michelle. Don't know if you know this, there's a whole slew of new pediatric dysphagia codes that are coming out next year. This year. Then they were talking about some specific dysphagia codes that are coming out. We were having conversations about what's happening. It was her, and I forgot the guy's name, but I went up to them, because I was like, low key, not trying to make myself known, but I was just like, I'm out here trying to help people in this area. There's a group of people that think ASHA doesn't do anything, but reimbursement@asha.org. I was told at that meeting, that goes to four different people. Literally, guys, this is what they do all day, every day.

I know the website can be a little hard to navigate, but reimbursement@asha.org is going to be your best bet. I say that in my coaching calls. I say it in my presentations. I say it in my courses. Use them, because I don't have all the answers. I'm just trying to make it more palatable for you to understand. This is what they do. I'm hoping this year, I get to go for that commitment again, because what they did was they wanted representation from each SIG. I was the only one in there that was keeping up, because everybody else is just either a professor, or some type of admin, and they weren't really into insurance like that. I was following along.

Then we had some other cool people that were there in the insurance realm. I forgot what their position was, but I was in my element. I was sitting there, eating it all up. Even though I don't have time, like I told one of my colleagues, I was like, ÒI need to get on that committee.Ó They were like, ÒBut Lauren, you do a lot.Ó I was like, ÒI know. I need to.Ó But I can put that as a goal, because Ð

[0:28:53] MD: Yeah. 2024. Claim it for 2024, because this is Ð But folks, that Ð Oh, so many thoughts, Lauren. So many thoughts. My ADHD just went like, ÒHoo.Ó This is the stuff, one, we're not taught in grad school. Grad school, and sharing Ð

[0:29:15] LH: Which I hope is really soon. I really hope, whoever sits on whatever board, just we need to have some type of business. That could be insurance, but a business class worked into our curriculum, for sure.

[0:29:34] MD: Okay. Professor hat. Wearing my professor hat, one, yes, we have to adhere to the ASHA Big 9, right? We have to get the concept of the ASHA Big 9 built in. But this is where within our clinic classes, we can embed this in our clinic classes, because you have students who are going to go out and they're going to be responsible for billing. A lot of, and you said it earlier, a lot of professors don't necessarily bill. They do the research to propel the field forward. They do that component, but they may not be in touch with the clinical aspect, right?

However, if you're a professor and you're involved with the clinic, or if you are an external clinical supervisor, the onus is on us to make sure that wearing those hats, we actually teach the students how to do the code. Now, they're not allowed to sign the line for final bill submission, but there's still an opportunity Ð

[0:30:37] LH: TheyÕll need to learn from someone who's committing fraud. Because there are people out here Ð I need to start looking up stories and posting them with my social media. Maybe I should do that. There are SLPs that get locked up. There are SLPs out here who are getting major fines. I had medically fragile kids on my caseload when I was in Atlanta, and nurses talk. You know how they always say Paris talk in the school system? Well, nurses talk, especially when you have these medical fragile kids. She was just like, ÒDo you go?Ó She listed a suburb that was way far. I was like, ÒYou know, I don't go that far.Ó She was like, ÒWell, that kiddo had an SLP, and then all of a sudden, she stopped coming. Come to find out, she got into some trouble and she's no longer SLP.Ó

This stuff is happening. My year four students, and this is why it was so funny, I have friends who are like, ÒYou're going to make it into the school system. Anybody else, not school system.Ó You want to make it on the university level in speaking, because, oh, at ASHA at my presentation, I was talking about different streams of revenue of income. They were like, ÒThat's going to be your other stream of income.Ó Oh, I know what it was. I was telling people in my session that you were pigeonholing yourself when you're just like, ÒI'm just going to do private pay.Ó I was using some of my favorite things, like a Target. I said, Target has multiple streams of income. You have the Target that has Starbucks in it.

[0:32:22] MD: Like that Target.

[0:32:24] LH: Right. I also used, I pay homage to Slutty Vegan, because yes, I was there before I [inaudible 0:32:30]. I used to stand in line Ð

[0:32:32] MD: Wait, wait, wait, wait, wait, wait. Take it back. What Ð

[0:32:36] LH: ItÕs called Slutty Vegan. I'm not going to go into the names of the burgers, because I was just professing the Lord, and I don't want people to think I'm Ð But I will say, one of her burgers is called One Night Stand, and I'll leave it at that. Slutty Vegan, I love her story. I was telling people that now that she has locations, she didn't get rid of her food truck.

[0:33:03] MD: Nice.

[0:33:04] LH: She has a food truck. She has her locations. She has merch. If anybody doesn't know what that means, that's t-shirts and cooks and stuff like that. I was like, every biz, yes. Every business that you see has multiple streams of income. As a private practice, why would you just say, ÒI'm just going to do private payÓ? I'll use my wonderful colleague and business bestie, Ebony Green. She has her practice. She has an office, but she also has home health, meaning that some of her therapist goes in the homes, and then she has school contracts. ThatÕs three streams of income. Every business when you look around has more than one stream of income. Why pigeonhole yourself to say, ÒI'm just going to do private payÓ?

To be honest, as a private practice, you are a service to your community. Just like your pediatrician is a service to your community. Unless, they're housed in a hospital, you are a service to the community. If your community is private pay, by all means, go forth and be great. But that's not every community. Some people pick the community that they live in. Some people might go to another side of town, whatever your heart tells you to do. Just know that you are a service to your community. You need to find out what your community needs. It's almost like research. You need to find out what your community needs, so that you can decide which one you want to do.

When people talk to me, it's like, the burden just got lifted. I'm like, you don't have to be an insurance provider for everybody. I know someone right now who's a school SLP. She only takes straight Medicaid, because she wants to see some kids at the school, sees kids after school and make some side money. That's it. She doesn't take Amerigroup. She doesn't take CareSource. She only takes straight Medicaid, because the billing is easy, and she don't have to worry about doing authorizations.

Because I have one negative comment in ever since I started my coaching business. I'll never forget it. This lady on Instagram was like, ÒIf you're promoting private practice, we're not going to have any school SLPs.Ó I said, ÒI'm not promoting a private practice.Ó

[0:35:37] MD: But those two things are not equal.

[0:35:40] LH: First of all, can I say, we're probably not going to have a lot of SLPs in the school system anyway, just because of the pay? But that's another story for a different day. I really think, side note, I will finish that segment. I think in the next five or 10 years, every school district across the US will either be infiltrated by contract companies, or you're going to get some smart SLPs, which they are a lot now. I've been hearing a lot of people starting to do it, which I think they've been doing it in rural areas. They're going to contract themselves out.

I don't think there's going to be a lot of straight hire SLPs in the next five, 10 years, but that's another day. But I told her, I said, I'm not promoting everyone to have a private practice. I'm promoting everyone to have a skill set. You didn't ask this earlier, but I'm just going to lead with what made me go into private practice. I thought I was going to be a school-based SLP. I thought I was just going to be one of them people that's going to retire about 56th in school. That was going to be my story.

My dad, who, which I told you, I was raised by my mother, got sick. Well, he had a lot of health issues. My sister and I had to move in back to Atlanta. My sister works a corporate job. We knew he had Ð I think we knew he was a diabetic, but we didn't know everything else. Of course, when he gets here and we get him set up with a PCP, I'm like, ÒOh, you got what?Ó Before we moved him from Florida, they were trying to put him on dialysis. That's actually what catapulted our decision, because our mom was on dialysis before she passed away. We were just like, ÒYouÕre going to die, because youÕre older and dialysis is going to take you out.Ó I hate to be so straightforward. That's just me.

We moved him to Atlanta. He went from having a PCP to now a cardiologist, to now a podiatrist. They want to see him every few weeks. I literally had to call. I was working for Soliant at the time. I had to call them Ð Actually, I called the school district first that I was working for in Atlanta. I was like, ÒI can't. I can't.Ó I know they said they will work with me. Literally, when you have four doctors wanting to see a person every two to four weeks, I was like, that's going to get old, right? That's going to get old.

I ended up finding a job at an outpatient clinic, who hired me before they had the demand. They did it backwards. You're supposed to get the demand and then hire the person. They thought, if they hire the person, the demand would come. That didn't last that long. It only lasted a couple months. Then I found a private practice. I told her. I said, ÒI'm only going to work with you for a year full-time. Then year two, I'm going to work with you part-time while I build my own.Ó She was supposed to train me. She did not. She did not have a full load for me. In my downtime, I started applying for my Medicaid application by myself and billed several times.

It took from October, November to March for me to get approved and not because they were slow. It was just because I kept Ð there was always this one thing wrong with my application, and I should fix it in a certain window. They just deny you. This is in Georgia. I don't know how it is in any other state. You just got to start over. I started the thing over about three or four times. The lady, when I parted ways with her, was very nice. She gave me three clients, because she was on one side of town, and those three clients lived on my side of town. I started my practice in June of 2016 with three clients. By December, I had 20.

[0:39:52] MD: Oh, my God.

[0:39:53] LH: Yeah. I always tell people, and I didn't have all the insurances by then. I just had Medicaid and all the CMOs under that one by then. Then I got Blue Cross Blue Shield later. I had TriCare, but I was one of those crazies, which you're [inaudible 0:40:11]. I didn't want to, because I know you can't trust everybody on these streets. That's why I talked against all these Facebook groups, because I just see so Ð

[0:40:22] MD: Much misinformation. People, do not go to Facebook as the trusted source, or the Instagram, or the tick of the tocks for the information on how to do these things. You need to find Ð there are trusted vetted sources. Trust to verify and where are the references?

[0:40:46] LH: Yeah. I was the crazy to say, I'm not going to listen to people. I'm going to sign up for all the insurances. I want to see if the reimbursement rate is bad, or not condusive for me. That's what I did. I was credentialed. Actually, I'm still credentialed. I'm still in the process of ending my contracts. No, no, no. Right for me. A lot has happened in a year. I was credentialed for all the insurances, except Sigma and Kaiser. I did all of them myself, by myself.

I wanted to see what the reimbursement rate was, because where I was, where I lived in Atlanta was the south side of Atlanta. I'm super close to the airport. It's predominantly black, but it's a mixture. It's one of those communities where you go down this street, it's low income, but then you turn on this other street and you see $200,000 $300,000, $400,000 home, right? It's a mixture. That's why I wanted to get Blue Cross Shield and Etna, United, because I know there are some corporations that working class people get, or I would say, middle class, whatever. That's why I wanted to see what the commercial ones look like. Yeah, that's what I did.

Then if I didn't like it, y'all, guess what? This is not like an apartment lease. You could just hit them up and say, ÒI want to end my contract.Ó I think a lot of people don't know that. When you sign up to be a provider for insurance, it is not like a lease. You can end that thing whenever. I mean, double-check and look, but all the Ð I say this. I am still a provider for United and Etna, because I haven't called for me yet. A lot of them will kick you out if you haven't, or put you as inactive if you haven't billed within 12 months. That's why I'm dragging my feet, because I really just want them to do it themselves, but I still have to reach out.

That's another thing you should know, too, if you end up moving states, or decide, ÒHey, I don't want to do this insurance anymore,Ó you have to reach out to them. I closed my practice last September. I can't believe it's been a year, because I moved to start a PhD program and I just didn't Ð I felt like learning a new state and how they do things out my brain. I just wanted to leave that extra space for school. There are some insurances. I'm still slowly reaching out to them saying, ÒHey, please. Basically, take me off your list.Ó Because two, shameless plug, when you do not call them, you are messing it up for someone else. This is why. When you hear people say, ÒOh, I called Blue Cross Blue Shield, but they said their panel is closed, or they're saying there are too many providers in my area.Ó That's because if someone had closed their practice, or decided not to take their insurance anymore, they have not contacted the insurance, so they are still active on their roster. You're one of those people?

[0:44:14] MD: I'm one of those people, because I didnÕt know that was a thing. Oh, my God. I'm a terrible human.

[0:44:19] LH: No. A lot of people don't know that. A lot of people think, ÒOh, if I don't bill, they'll just take me off the list.Ó I would not doubt if you go on their website and look up SLP providers, your name is probably still there, even though you probably haven't billed.

[0:44:35] MD: Well, I know my CAQH has expired. Wait, okay.

[0:44:40] LH: You want me to explain that?

[0:44:42] MD: Yes. Okay, so backtrack. For those of you that are like me, that are like, these are very difficult and confusing things, I contracted a lady to do all of this. Our ASHA Star did all of this for me. Andy did it. Then ASHA Star is the state representative to the National Association on private practice and Medicaid. No. I said that one wrong. Private insurance. Pardon?

[0:45:10] LH: I know that what star meant. They'll start with a part of them. I just didn't know what their role was.

[0:45:16] MD: Each state association, you're right, they should pay for a lobbyist. There's some that don't have a lobbyist, which is terrifying and a whole other conversation, but that has to do with the state budget and that's our state. They all have a star, or a stamp, or a smack. I think smack might have been renamed, because that's just funny. But one is the school's representative on best practice. One is the private practice, Medicaid, and one is the Medicare, and the liaison between Asha and the individual states. That way, there's a constant stream.

Andy did mine. I remember when Ð so, I moved to South Carolina coming from a hospital, where I did inpatient, outpatient pedes through adults that helped me. That was my CF and my second year working. That was two years. Then I got an early intervention and I found out the first person didn't have me credentialed and was billing under all my stuff through her. Didn't know about that. Oh, yeah. Then I went to the second lady. That was only a couple of months, thank you, Lord. But went to the second lady and she started getting me in as a 1099 to her, but I still wasn't in network with everybody.

She set up the CAQH with her passwords and her logins and did it. I didn't know there was something called a CAQH until Andy. Andy was like, ÒSo, we're going to take all of this from the top.Ó Bless her stars, because had she not mentored me, I wouldn't have known. I mean, she took her pay out from everything. I mean, I paid her for it. It wasn't for free thing, because mentorship of that kind does need to be paid, in my humble opinion. That is work, right? Yes. But I still don't really know what is CAQH, [inaudible 0:47:12].

[0:47:13] LH: I can tell you a minute flat. When it comes to Medicaid, most Medicaid departments in whatever state you pick, they have their own credentialing department. Credentialing basically means, when you hear people say, ÒI got to get credentialed. I got to get credentialed,Ó that basically means, you turn your stuff in. I want to give you some tea, y'all. Spilling the tea, right? I will give you some tea.

[0:47:39] MD: Love it. Love it.

[0:47:41] LH: Applying to become an insurance provider, you don't need a lot. You really just need your liability insurance, your state license, the application. That's basically it. I feel like, I might be leaving something out, but that's basically Ð and any extra forms that that state has attached to that. It might be, I don't know. They just have some really dumb forms. All you have to do is sign it.

[0:48:11] MD: When you say state license, you don't mean voter registration, or driverÕs license. You mean, your state SLP license?

[0:48:16] LH: Your state SLP license. That's all you need. Not your ASHA Cs. You just need your state SLP license, liability insurance, of course, business name. That's what I was missing. Business name, all that stuff, because you want to apply as a group and not as an individual, because life be, life-ing. I always use my dad's story in all of my presentations and courses, because unfortunately, I didn't say this part, but my dad ended up passing away, like a year or two later. I'm just glad I had that skill set to pivot and be there for him and to mend our relationship, or at least attempt to during that time.

I'm so passionate about people knowing this process for themselves, because life be, life-ing, okay? Can I just put my little A in there? Life be, life in. I just want people to have this in their back pocket. If anything, God forbid, happens to you, or your spouse, a partner, or someone that's a really close relative, you're able to pivot and make a life for yourself and not have to choose between family and your career. Anyway, let me go back. See, my ADD is kicking in.

[0:49:41] MD: I of all people understand.

[0:49:46] LH: If you can follow me in conversation, we're friends for life. Medicaid has their people, their inside people who, so credentialing is just checking to make sure your license is active, even though you might give them a copy, they still have to verify that, right? They are basically verifying everything on your application. Well, when it comes to commercial insurances, they do not have a credentialing department. That's where CAQH comes in. I tell people, because Facebook, here we go, everyone's like, ÒI don't have a CAQH.Ó People always tell me that. I'm like, do you plan on taking Blue Cross Blue Shield track here? Like Kaiser? Do you plan on taking those? I don't think so. Then you don't need one. You don't need one.

Now, is it good to have one? Absolutely. If you don't plan on taking those commercial insurances, and I know certain states, a mayor group, I believe, might use CAQH. Rarely, when it comes to Medicaid and CMOs, you don't need CAQH, because they credential you through their in-house people. CAQH though, because times have changed, like you said before with the students now, because I talked to a Ð actually two classes, but one in particular at Purdue about insurance billing. I had to drink a whole cup of water after I was done, because I only had an hour. I was basically telling the students like, know the codes for yourself. Now that especially Medicaid billing is in the school system, to your point, yes, these universities need to start having these conversations about billing appropriately, right?

Because now, before you used to just be in our medical practicum, but now it's also in the schools, because the schools bill Medicaid. Because of that, I tell people when they come to me, you probably already have a CAQH account. You probably just don't know it. To your point, Michelle, I have one, because I worked at an autism center when I was in Nashville, Tennessee. They created one to give me credential through the insurances. I remember, when I was starting this journey and learning about CAQH, when I went to sign up, and I put my information in, they said, I already had an account. I was like, ÒWhat?Ó

I tell people now, call CAQH. I think they're going to ask you for your birthday, maybe your social, and they will give you the login information. Some people are like, ÒWell, what about my other employer?Ó I was like, that's between you and them. That's your information. You should have access to it, right? Because when I saw the login, I said, I know somebody made this, because I don't even use that as a username.

[0:52:48] MD: That was mine. I was like, ÒWait. Who is this person?Ó I was like, ÒOh, my God. That was not me.Ó

[0:52:53] LH: Yeah. You got to make sure all your stuff is in there, because I don't got a name. You didn't say no names, but whoever did that for you, some people will put their information in there, and well, their information for contact, right? Which technically, they should, but they should give you the login. I want to say that again. You as the person should have the login. But when I went in mine, I saw the school districts that I worked for in Tennessee were still in there. I had to go and clean that up.

One of my actually, undergrad colleagues, she posted on Facebook that she found out, because she started her private practice. This insurance was sending her former employer, her reimbursement checks.

[0:53:45] MD: Because she didn't have a CAQH.

[0:53:48] LH: I haven't reached out to her, which I have it. I have undiagnosed ADHD. I need to double back to her to find out if she took them off of her CAQH. Now, for anybody who's like, ÒBut what if I work part-time for somebody else?Ó You can designate that. But when you go in there, itÕs like, there's a hierarchy. If you're working for yourself majority of the time, or even if it's half and half, I will put you first. Also, too, let me dispel this myth, because I see this on the Facebook groups about, ÒWell, I don't want my current employer to find out that I'm applying for insurance.Ó Y'all, they don't do that. Insurance world is too big to let your current employer know that you now have your own Medicaid number. It doesn't happen that way.

[0:54:43] MD: I will admit, I was petrified of doing that for that reason.

[0:54:47] LH: No. Let me give you some tea, some more tea. With Medicaid, in particular, because that's the easiest example I can use in this scenario. Medicaid, your number ends with a letter, right? By the time I started my business, the letter on the end was D. I knew that would be, because A was probably the school district that first credentialed me, because I was a part of the first crew in Tennessee when they started billing Medicaid in 2011. That was A. B was probably that outpatient place that I worked for, for a little bit. Then C was the private practice I worked for, and then D was myself.

Now, let's say, we did have that perfect setup where I was still working for that private practice, and then working for myself. Well, she would be building under my Medicaid number with the C on the end. When I was doing stuff for myself, I would be billing it with a D on the end. Does it make sense?

[0:55:58] MD: Yes.

[0:55:58] LH: Medicaid, and they will keep going, and I'm laughing, because one of my part-time employees, I think she had J. She had been down the Ð She had worked for so many people. Just know, you can still work for yourself, or for people who just want to make a lot of side money. If you want to work for multiple clinics, you can. When they credential you, they would just have a different letter behind your name for Medicaid, right?

Now, when I first started, come to find out, my previous employer did not remove me from her roster. I remember the first time I was trying to get an authorization approved, and they were like, ÒSo is it for this company, or is it for this company?Ó I was like, ÒIt's for here to speak. Please make sure the other one is off my name. Please take the other one off my name.Ó That only happened maybe once or twice and didn't happen again. Because to my other point, even when you lose employees, you need to call the insurance and say, ÒThey are no longer working for me.Ó ThereÕs still a space. Does that make sense?

[0:57:10] MD: Yes. If we're NCAQH and we go in and update that, does that matriculate back to the insurance company?

[0:57:17] LH: Not to Medicaid. Only to the insurances that Ð

[0:57:23] MD: The private insurances.

[0:57:26] LH: You know what? I've let my CAQH lapse, and I'm hoping United Healthcare will get the picture, but I'm probably still going to call them just to double check. Because I still get the monthly newsletters. That's how I know. I'm like, ÒOoh. I need to call them, because I'm still getting the provider monthly newsletters.Ó It's just good to call and/or contact your rep for that insurance to let them know that you want to end the contract. I know I did it for Blue Cross Blue Shield. That was my biggest one, because I know so many colleagues back in Atlanta who want to get on that panel and they keep saying they have too many in that area.

That was my main one. The other ones, that's why I'm dragging my feet, because not everybody's trying to run to Etna and United Healthcare, because theyÕll give me some OT. When you learn about deductibles, it will open your mind. If people have high deductibles, they're going to end up being private paid, because it is going to take them a very long time to reach their deductible. Insurance, they don't start paying anything, whether it's a small percentage, or a bigger percentage, or a 100%.

Insurances don't pay a 100% until a person has met their deductible and they're out of pocket. When they hit the deductible, whatever percentage, it could be 80%, it could be 30%, that's when the insurances will start paying. If you get a kiddo and that's why a lot of people probably don't do United and Etna, because I've seen some high deductibles. If you get a kiddo with a $10,000 deductible, you and all they got is speech, they don't have any other medical conditions, it's going to be really hard. I told this dad once that he told me, he was like, ÒYou've explained insurance better than the HR at my job.Ó I told dad, I said Ð

[0:59:22] MD: ThatÕs amazing.

[0:59:24] LH: Yeah. I said, ÒTake everyone to the doctor.Ó Everyone, take them all. Take them all. Take everyone to the doctor, because that helps your deductible. The way it works is whatever you spend, or let's say, given your plan, you only pay what? $20 for your PCP, whatever that amount is Ð let's say, your doctor's visit is the allowable amount is $200 and you only pay $20. Well, that $180 goes toward your deductible. If you get these parents, and let's just be honest, low-income parents don't always take their kids to the doctor. That's how you get, or even, I would say, black people. Can I just go out and say black people sometimes? We just go when we have to go.

Especially after they do those yearly wellness checks, after that, they don't really go, unless the kid is sick and they [inaudible 1:00:24] and about audits. When you don't go to the doctor, your deductible doesn't get touched. Then when you want to get therapy, you're going to have to pay that copay for a while, until that deductible gets met. We hope to God that your deductible is not big.

[1:00:48] MD: A $1,000. Sorry, I'm thinking of ours. Ours for my husband's insurance, it's a $6,000 deductible.

[1:00:53] LH: See, six is good. Six is good.

[1:00:56] MD: I know. We had to take Bear to the cardiologist and they had to do Ð and thank the Lord, everything came back fine. He has the exact same extra heart. I get an extra heartbeat randomly for whatever reason. But they had to do an echo. They had to do an EKG. They had to do the chest harness, which he sweated off running across the front yard. It scared him when it fell down his pants. He goes, ÒMom, it tried to take out my tally whacker.Ó I was like, ÒWhat?Ó It fell right off and he was running ahead and it is bits and pieces. I mean, when I got the bill for that, I was like, ÒOoh.Ó

[1:01:36] LH: Yeah. But that went to your deductible.

[1:01:39] MD: Oh, yeah. Our deductible will be met very quickly this year. Thank you.

[1:01:45] LH: Hypothetically, if he had to go to a PT/OT, or speech therapist, you won't have to pay, or you only have to Ð do you have any co-insurance, like a 20%, a 30%, do you know?

[1:01:56] MD: 20%.

[1:01:57] LH: 20%. You only have to pay 20%.

[1:02:00] MD: Yes. Yes. Okay.

[1:02:05] LH: ItÕs a lot.

[1:02:08] MD: ThereÕs a lot. I had a couple of thoughts. One, I've had patients ask Ð well, not patients, but I've had colleagues as patients. Can you tell where my head is today? I've had colleagues ask, ÒWell, can we do it for free for individuals that are in that gap? Like, Medicaid to private insurance and they don't have insurance or ÐÓ Here's the catch. At a university level, if we, and at certain private practices, there's laws that if you are billing, then you can't offer free services.

[1:02:46] LH: Yes. People need to know that, because I Ð another Facebook thing, I have seen people say, ÒWell, they're not going to hit their deductible and I'm not going to get paid. I'm just going to charge them private pay.Ó No. Once you have their insurance information, you have to charge their insurance. Now, I'm just a good Samaritan that I still build their insurance, because guess what, y'all? That goes toward their deductible.

Now I, and I saw this on Facebook, too, and I had to refrain. Y'all don't know how many times I have refrained making comments on these groups, because I'm like, ÒNo. That just shows you, you don't know what you're talking about.Ó I know for a fact, I billed Blue Cross Blue Shield. I think they had HSA and mom paid me out of that. She told me, me billing insurance helped them in their other doctor's appointments. It didn't help me, but it helped them in other doctorÕs appointments. Because like I said, that's still going to the deductible, because the claim is going to say, this is the allowable amount, patient responsibility.

[1:04:00] MD: Yes. Yes.

[1:04:00] LH: She had all the receipts to that, if that came up later on on how much money you spent and most parents will ask you for that receipt toward the end of the year for taxes and stuff like that. Once you know that they have insurance, legally, you're supposed to bill their insurance. You're not supposed to just say, ÒOh, I'm not going to get it, so I'm going to pay private pay.Ó Also, too, I have warned people. I said it at my ASHA presentation, because everyone, should I call it the lazy way? No, because that's being judgmental. Let's just say, go in the super bill way, it's cool if it's just one or two people, but if you're doing that for almost all of your kiddos, again, you're not Ð

[1:04:52] MD: Wait. What do you mean, super bill way? Because when you say super bill, I think the super bill PDF template that ASHA has, but it just list out all the CPT codes within access.

[1:05:01] LH: Yes. Super bill, for anybody who doesn't know what that is, if you are not a provider for an insurance, but the parents want to get their money back for all the money they're paying you out of pocket, you fill out a super bill to basically say, ÒThese are the codes I would use if I was billing. This is how much the parent is paying me.Ó They turn it into insurance and they get the money back. I warn people during my presentation to say, if your private pay rate is a $100 and their allowable amount is $70 and the insurance only reimburses them $70, you might run the risk of them coming back and asking you to just charge them $70. You see what I'm saying?

You got to be careful when you are Ð which let me say for the record, I do think, I don't care what state we're in, I do think our cold reimbursements are way too low for our expertise in what we do. I'm not shaming the $100 rate. Let me be very clear. I think that we all definitely need to get paid way more than what we do in our state. However, you just got to be tricky, because you might get that one parent when they do find out the allowable amount, and I don't know that much about super bill, because I feel like, if I don't do a super bill, I might as well just become a provider. It just makes more sense for me.

That's more paperwork. I don't want to fill out a super bill for you to turn that. To me, that's extra work. But if it works for you, works for you. But just be careful, because what if the insurance doesn't reimburse them for that whole amount and they go off the allowable amount? I always tell people, when you make your rates, try to be Ñ not at Medicaid rate Ñ I always tell them to do maybe $20, or $30 over, just because when you bill insurance, especially, hint-hint, always use the EMR system. Make your life easy. You got to keep the same rate. To your point you made earlier, Michelle, we ethically, legally, it will be crazy if one insurance you're billing for $80 and the other one you're doing $100. Just do a plain Ð

[1:07:35] MD: One way.

[1:07:36] LH: That's why I always say, make your rate that you bill a little bit higher than Medicaid, because Blue Cross Blue Shield y'all, spilling some tea is the best commercial insurance out there. In my experience, they do pay over the Medicaid rate. You don't want to build insurances the Medicaid rate and then you're losing out on some money. I don't care if it's $5, or a dollar, you want all them coins for that allowable amount. Always Ð

[1:08:09] MD: All I can see was Bear's booger coins on the kitchen counter where se set that. Okay, now weÕre talking. I charged Bear, because I'm tired of cleaning up. This is a Bear episode. I'm tired of cleaning his boogers off the new furniture. Every time I catch the kid with his finger in his nose, he owes me a nickel. I had 25 cents in the first hour. As you were talking, I was like, ÒBear, I would take all those dollars. Those coins Ð IÕm taking that coin.Ó I'm so sorry.

[1:08:36] LH: No, itÕs mine. We already don't make what we're worth. You want to make sure that you are building over the allowable amount, so that you're getting the full allowable amount. That's what I suggest for people to do, because each insurances have different reimbursement rates. You want to make sure you're getting that entire amount. Just in it, I know we have to wrap up some, but I just want to Ð Michelle had a trusted person to do her credentialing, but I am so against putting somebody to do your credentialing. Maybe it's because Ð unless you had someone like she did, like Erin. Okay, go. Go forth and be great.

I'm not going to give my information to a credentialing company. One, they charge way too much. I always tell people, if you can fill out an apartment application, you can fill out an application to become an insurance provider. The reason why it's confusing is because some insurances, they don't have different applications for different professionals. When you see that section that says, ÒDo you have hospital rights?Ó That's for doctors. Just skip over it. I think we as type A SLPs, we want to fill out every single section. It's like, no. That doesn't apply. Just skip over. They're not going to throw your application out. It just does not apply to us. You just skip right on over that.

[1:10:07] MD: Hospitaling privileges. That was the one that always threw me on the questions. Do you have hospitaling privileges? I was like, ÒWell, I can work in a hospital.Ó Then I Googled it. I was like, no, I do not have hospitaling credit. It was at that moment in time that I had to share panic and was like, ÒAndy.Ó But it was only because it was her. You were right. If it wasn't her, I wouldn't have gone to. If it wasn't her, I don't know I would have opened a private practice up, because I would not use these other companies.

[1:10:39] LH: A lot of people are scared. I mean, Michelle, I was out here. I'm going to be honest, because of what I went through with my dad and because of what I've seen on the Facebook groups, that's literally why I started my coaching business. Because the few people that I mentored in my friend group in Atlanta, they were like, ÒYou really should start this as a business.Ó I was like, ÒNo, I'm okay.Ó They were like, ÒNo, you're really good. You really know your stuff.Ó For a long time, I was questioning myself. I'm glad I don't remember her name, but I'll never forget, I connected with somebody on a Facebook group. Then we started private messaging each other on Facebook.

When she told me she spent $2,500 to have a credentialing company, credential for five insurances, because it was $500 per application Ð and I keep hearing this and it just drives me off the wall. I just don't have time. I just don't have time. Y'all, when, insert curse word, hit the fan, ASHA and the state are going to come looking for you. They're not going to come looking for that credentialing company. They're not going to come looking for that billing company, because that claim is going to have your name on it and your NPI on it. I tell people, I'm like, ÒListen, I had a biller once upon a time. I did. I'm not against having an in-house biller. What I'm against is you not knowing, because that's your name.Ó

[1:12:13] MD: Yes.

[1:12:13] LH: When you see the ASHA leader and people getting their fees revoked and all this stuff like that, it's because their name was on those claims. I just promote, don't be hands-off. Know it for yourself as an owner. Even if it's you, yourself and I, and you're going to delegate it to somebody else. If you're going to get a biller, you should be meeting with them every week. You should have all your passcodes. You know what I'm saying? My in-house biller, we talked at least once a week. She would call and say, ÒI know you see such and such claims sitting in not paid. I'm working on that.Ó I call them. They said, such and such. It's like, she went Ð Let's say, I had five claims in my unpaid tab. She would give me the lowdown on where she was and working on that claim. If you're not having those conversations, this is how people lose money.

[1:13:07] MD: Or go to jail.

[1:13:08] LH: Or go to jail. These billing companies take 20%. Even with me paying my in-house biller, I mean, I let her go around COVID, because when COVID hit, my part-time people weren't working. It was just me and even my case load shrunk a little bit. Yes, I still worked during COVID. Did not stop. That whole shelter in place, I don't even know what that looks like, because I never did it. I think at the time, before I let her go, I think she was at, was it five hours every two weeks? Because I paid her every two weeks.

It wasn't that much, because we had straightened out stuff so much. I didn't get a lot of not paid. I said all that to say, it's almost like, getting a financial advisor. You know how with celebrities, they might take a percentage. With a financial advisor, they can either take a percentage, or you pay them hourly. It's the same situation. Get a biller where you can pay them hourly. Then if you don't have anything, guess what? You don't have to pay them, because there's no work for them to do. You see what I'm saying? I want people to keep their money.

We already, as we already discussed, certain states, the reimbursement rates are terrible. We already don't make enough for what we do. I just want you to keep it. I just want you to keep it. That's all I'm saying. Understand the CPT codes. Understand which ones you can build together, which ones are not. Yeah. That's what really just grinds my gears. I just really just want people to know it, because there are people who are making six figures, who still got a lot of outstanding claims. Don't let these people out here fool you that they Ð yes, they have successful businesses, but ask them, Òare all their claims paid?Ó I know that sounds a little like you meddling. But I'm just saying, if you put these systems in place on the front end, then as you grow and as your business grows in revenue, then you won't have anything.

Last story, because I got so many. A friend of mine, she and her classmate, I don't know, I forgot to ask her, are they still friends. But she said that they lost $300,000 when they first got started, because the biller that came highly recommended, she said wasn't scrubbing the claims. I was like, ÒScrubbing? What do you mean by scrubbing?Ó She was like, ÒMaking sure everything's there.Ó Then I had other questions, because this is why I tell people, ask the right questions with these EMR systems, because the EMR system should be scrubbing it to making sure that, okay, a birth date is there, a name is there, all the right components are there before you send it off. Doing it by hand, that's way too much. But anyway, I digress. Because the biller was just billing it, they had all these not paid claims and lost $300,000.

Now, they did go back and did some corrections, but FYI y'all, a lot of these insurances have a window that you can correct and keep sending it back. Once that window is gone, they will not pay that claim. My other passion within this is, don't go with the EMR system that you see a lot of times at ASHA. There's nothing wrong with them. I'm just saying, shop around, ask more questions. Do they have a clearing house? I have that on Ð I actually just made a freebie on my Instagram about that. These are the questions you should ask the EMR system when you're shopping for one. Try one out, because a well-known one, which will remain nameless, they don't have a clearing house. A clearing house is important, because when you send the claim from your EMR system, it goes to a clearing house, they make sure everything's straight and they process it and they send it to the insurance. Then they send it back through the clearing house and that's how when you open up the EMR on the billing side, it'll tell you how much you got paid for that claim. 

Well, this particular one, they don't have their own clearing house. A friend of mine who uses this software had to go and make his own account for a clearing house. I was like, ÒOh, my God. You shouldn't have to do that. That should be part of the EMR.Ó

[1:17:43] MD: It for the ones. Yeah, thatÕs in.

[1:17:44] LH: If anybody's interested, find me on Instagram, @sassyslp. Literally no special spelling. ItÕs literally @sassyslp. I made a freebie called like, what questions you should ask the EMR. Shop around. Don't just go off the ones that pay all the big bucks to be on ASHAÕs advertising. Make sure. Go check them out, too. I have nothing against them. I just don't want people to feel like, you have to do Ð It's almost like commercial. You see commercial so many times, it's like, I want that one, because you see a lot. You need to dig down and ask more questions.

[1:18:23] MD: My sons have picked out their own cars, because of the commercials that pop up on their tablets when they're playing. Whatever is currently being advertised on Ð whatÕs that little imposter game with a little astronaut guy that goes through and they Ð I don't know. It's a cheesy little game. It's gone. Whatever. I agree. That's going to drive me crazy, because you know how many times IÕve Ð they've studied YouTube to figure out how to beat this game. Okay. Anywho, what is your website?

[1:18:56] LH: Oh, my website is heartospeakacademy.com. H-E-A-R-T-Ospeakacademy.com. You will find my courses there. You can sign up to speak with me, have a coaching call. Yes, y'all, just let's be better. Let's just be better.

[1:19:18] MD: Yes. Lauren, I love you. This was, oh, my God. Come back. Come back and do another one. Can you come back and do a part two on like, okay, you're in it and you've made bad choices and here's the recovery process?

[1:19:31] LH: Yes.

[1:19:32] MD: Yes. Also, I made a note to get you to come talk to the students in the spring semester. You saw me writing and I was like, okay.

[1:19:41] LH: I saw you write. All right. ThatÕs [inaudible 1:19:42].

[1:19:44] MD: Well, my agenda only goes through to December, so I have you written down for the beginning of December. I was like, that way, I can get her to come for the spring semester. Before they go out for their summer clinical, like out Ð

[1:19:57] LH: Yeah. Yeah. Yeah.

[1:20:01] MD: Okay. Thank you. Okay. I feel like a schmuck, because I have to go, because I have eight minutes Ð

[1:20:06] LH: Yeah. I was going to tell myself Ð

[1:20:07] MD: Oh, no. Folks, this is Ð

[1:20:11] LH: DonÕt be a hard stop. I looked up and I was like, ÒOh.Ó This story.

[1:20:17] MD: Okay, wait. We have to get in who Ð if somebody wants, has love money, who and where can they donate it to?

[1:20:25] LH: There's an organization called Student Without Mothers. I haven't gotten involved with them, but just reading the title struck me, because my mother passed away the summer before my senior year in high school. I've been following them and I have always had it Ð I have a long to-do list in the back of my head to connect with them and give to their organization. Yes, if you look, especially on Instagram, you look for Students Without Mothers, it's literally for kiddos who are without a mother, whether they have passed away, or I think that's the only reason, but it might be other reasons. Yes, Student Without Mothers. That would be something that is near and dear to my heart.

[1:21:14] MD: Got it. Thank you for being you.

[1:21:19] LH: Oh, thanks. Thank you.

[1:21:22] MD: Okay.

[1:21:22] LH: All right.

[1:21:23] MD: Okay.

[END OF INTERVIEW]

[1:21:27] MD: Feeding Matters guides system-wide changes by uniting caregivers, professionals and community partners under the Pediatric Feeding Disorder Alliance. What is this alliance? The alliance is an open access collaborative community, focused on achieving strategic goals within three focus areas; education, advocacy and research.

Who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder. To date, a 187 professionals, caregivers and partners have joined the alliance. You can join today by visiting the Feeding Matters website at www.feedingmatters.org. Click on PFD Alliance tab and sign up today. Change is possible when we work together.

[OUTRO]

[1:22:20] MD: That's a wrap folks. Once again, thank you for listening to First Bite: Fed, Fun and Functional. I'm your humble, but yet, sassy host, Michelle Dawson, the All-Things PFDs SLP.

This podcast is part of a course offered for continuing education through speechtherapypd.com. Please check out the website if you'd like to learn more about CEU opportunities for this episode, as well as the ones that are archived. As always, remember, feed your mind, feed your soul, be kind and feed those babies.

[END]



FBP 257		Transcript

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