Episode 44 - Expanding Services with Confidence: How to Add OT, PT, and ABA to Your Practice

Aaron Marshall (00:24)
Hey welcome to the spot growth podcast this is your host Aaron Marshall with extra mile billing and I am super excited to welcome back Jennifer volts ronco to the podcast today welcome Jennifer.

Jennifer Voltz (00:38)
Thank you for having me. Good morning.

Aaron Marshall (00:40)
⁓

absolutely. We love having you on here. And ⁓ today we're talking about, ⁓ I think a topic that interests a lot of our listeners, but even a lot of my clients ⁓ who, you maybe they're an SLP and they started a speech business and, and they don't know if they want to make the jump into OT and PT or I'm an OT and I can do PT, but I don't know if I'm ready to make the jump into speech. seems kind of, you know, they,

There's always questions. There's always like, what am I not thinking about? So as the owner of Focus, which is a

Jennifer Voltz (01:15)
So,

Aaron Marshall (01:17)
speech, physical occupational therapy business and ABA services, ⁓ and as the new president of the Alliance for Pediatric Therapies, congratulations. ⁓ Yeah, I just wanted to have you on and just kind of. ⁓

Jennifer Voltz (01:18)
I

Aaron Marshall (01:33)
maybe dispel some of the rumors, some of the myths, and just give people confidence to be able to jump in and offer more services at their locations. So

Jennifer Voltz (01:35)
love it.

Aaron Marshall (01:41)
yeah, so that being said, I guess from your perspective, what's the biggest benefit of offering a multitude of services under one roof?

Jennifer Voltz (01:50)
Well, I think it ⁓ really, really improves your quality of care. So when I, I'm a speech and language pathologist, ⁓ but when I started working right next to an occupational therapist with the same kids, I learned so much and my sessions became even better in my opinion. ⁓ You know, from occupational and physical therapists helping me with their, ⁓

the way that children were sitting to get more attention out of them and focus, like all of those things just helped provide a better service. So that was the number one reason why I decided to do it. ⁓ And then also I just felt like parents really nowadays love convenience. And so a one stop shop is ⁓ a huge benefit for families instead of.

taking their child to the speech therapist and then driving across town to the OT and then another place for PT, having it all in one place is probably the most convenient and what parents want the most.

Aaron Marshall (02:48)
That makes sense. I hadn't even considered the improvement in quality, ⁓ but that makes so much sense. Do you do that with therapists? Do you have them rotate around with those other disciplines so they get that same refinement?

Jennifer Voltz (02:53)
⁓ yeah.

yeah, our clinic is set up a little bit more uniquely than what you would imagine for a speech therapist. We don't have private rooms and therapists sitting behind a closed door treating kids in privacy. We have a very open gym format. Each therapist has their own space, they have their own table and their own workstation, but we're all sitting right next to each other. We're doing group games, we're incorporating different skills. So you're really getting a lot more bang for your buck if you bring your child to.

our practice in my opinion for that reason.

Aaron Marshall (03:38)
That makes so much sense. I just never even considered it from that direction. that's, I mean, I think that's a really cool model and really cool way of tackling it. So when you're, you know, when you decided to expand, when you were like, hey, I'm going to offer most of the, or if, know, I'm a speech therapist and I want to do what you did, what's the very first step that you would recommend that they take?

Jennifer Voltz (03:47)
Thank you.

So it was a learning experience for sure. So I would love for other people to learn from my mistakes. But the biggest thing is starting with your MPI. ⁓ Your MPI, if you are a single ⁓ group provider and you only provide one discipline, you're going to need to change your MPI or add another additional MPI. ⁓ And then if you have like a group ⁓ provider Medicaid number, you're going to have to change that too. So your business dynamic is going to change. So you need to make sure you cross all those T's and dot all those I's.

And then, you know, I am a firm believer in surround yourself with people that are smarter than you. So reaching out to, you know, occupational therapists and physical therapists, if you're a speech therapist, that you really respect and look up to and just learning from them and understanding the dynamics because all of our professions operate a little bit differently, different diagnosis codes, different testing material, all of that stuff.

Aaron Marshall (04:55)
Yeah.

No, that makes sense. I guess from an insurance company perspective, because you start out, you don't even plan to add OTMPT. You're like, don't even think about that. I just want to make more bang for my buck as a speech therapist, and I'll add a few speech therapists. But you're not even thinking about insurance companies and contracts and things like that. how do insurance company contracts and credentials work?

Jennifer Voltz (05:02)
Yeah.

Aaron Marshall (05:23)
when you're adding those new disciplines.

Jennifer Voltz (05:26)
Yeah, that's a really good question. So you have to look at your contracts that you have and sometimes that is just tricky in itself. ⁓ And so you need to reach out to a representative from the insurance company and say, would like to add these services and you have to go through the whole credentialing process again. And sometimes it's a matter of just adding an addendum to your contract or sometimes you have to get a whole new contract.

So you definitely want to make sure you do all those things. ⁓ And then, you know, like the licensing and stuff like that, making sure, and then contracts for the people that you're going to hire. So making sure those contracts reflect what you need them to, that you're covering all your bases.

Aaron Marshall (06:05)
That makes sense. I guess, you know, there's a way to go about it there's a way not to go about it. So I guess what would be like a mistake or like a pitfall that you might see that a practice if they're trying to expand too quickly, what, you know, they missed a step. What do you normally see as them missing a step there?

Jennifer Voltz (06:23)
Well, is the MPI number change or the tax? Well, the tax ID should stay the same, but you're going to update MPI and or add additional ones. When I added ABA services, that was the trickiest for me because it's different than speech OT and physical therapy. Getting authorization for services for speech, OTPT is all under medical benefits. I didn't understand that ABA was under.

mental health benefits for a lot of insurance companies. I'm sure that I understood how to just go about getting those authorizations. So a good service rep or provider rep that you can reach out to for each insurance company is helpful. ⁓ I do consulting on the side, so I'm happy to help other practitioners, but I would say also the Alliance for Pediatric Therapies, I joined that group, that nonprofit group. ⁓

right when I opened up my practice. And that was very helpful to talk to other providers to ask them questions because you might get some terminology thrown at you that you're not familiar with. ⁓ Yeah, all of those things.

Aaron Marshall (07:32)
Right.

Man, so I guess that is a big difference between the spot side of the business, so the speech, physical, occupational versus the ABA. And with the spot side, mean, correct me if I'm wrong, but you could really just update your MPI and update your ⁓ Medicaid group number, is that right, to include that multidisciplinary?

Jennifer Voltz (07:50)
Mm-hmm.

Yes, yes, that's what you would have to do. You would have to be a, yeah, I believe it is multidisciplinary or a multi-specialty. think it's called the MPI is multi-specialty. And then the multi-specialty I thought covered ABA. does not. So multi-specialty covers the speech OTPT. ⁓ And so I learned by mistake that I had to get an additional MPI number and your tax ID can have several MPI

That's not a problem and your company can have several, several NPI numbers. ⁓ So yes, that was, that was something that I needed to learn as I went and made sure that I was set up appropriately instead of just going out there, giving the services and then having to backtrack.

Aaron Marshall (08:40)
Right. And I think that right there, even that little change kind of scares a lot of people because they're like, no, I'm a speech company. Like, what can I do? So just knowing and understanding like, it actually is a pretty simple NPI change to add those other services because they are all, you know, from a state perspective, they see them all as very connected, even though they're very different services, they see them all as very connected in that way. that multidisciplinary, you know,

Jennifer Voltz (08:48)
Mm-hmm.

Yeah!

Wreck

Aaron Marshall (09:09)
label really applies to all three of those.

Jennifer Voltz (09:12)
Right. Yeah. And then also just, you know, once I started going, I definitely was grateful for the friendship that we have because I could reach out to you and say, you know, I'm not understanding why I can't bill speech and OTI same day. How does that work with private insurance? Is it one copay? Is it two? Do you, do you go past how many units you can bill? So I mean, knowing a good biller is also a very good benefit and very

Aaron Marshall (09:36)
Absolutely.

Yeah, thank you for the plug. So I guess, know, financially there, you know, there is some risk with adding different disciplines because, you know, some of the disciplines require different kinds of space issues. So, you know, when you're expanding your clinic, what are the things that you're thinking about financially when you're adding these new services?

Jennifer Voltz (09:57)
Well, the tricky part is that some insurances, when you go to get credentials, they need a name. They need a therapist. So if you want to add OT and you're a speech pathologist and you want to add PT, you need to have people. And it's backwards because you can't give them work yet, but you need to supply this information to the insurance company. So how you want to work that out with different professionals.

You're going to have to kind of think outside the box. The way that I did it was I just ⁓ did independent contractors right away and just said, hey, this is what I have in the works. Would you be willing to do that? And I found some people that were agreeable to that. And then once I got all of that paperwork worked out, then we could advertise. And of course, being that I already had my speech therapy patients, plenty of them were in need. So I knew that I had a caseload for somebody.

Aaron Marshall (10:50)
What about like gym space and things like that? Is that something that you need to have like right away if you're a speech pathologist adding OTMPT into your facility? What would you say about that?

Jennifer Voltz (11:00)
would say it's definitely helpful to have some additional space because their services are going to look different than ours. mean, my OTPT therapists definitely love ⁓ obstacle courses, so they can always for that. As far as a big gym and large equipment, I mean, that can grow as you grow. So it's not like that immediately. again, reaching out to people that are smarter than you that are very good in their profession and asking them like, what are the essentials? I think

You know, a trampoline is an easy essential, some things that they can climb on. And then, you know, the main test is the bot, I think is very helpful for OTPT that want to add that. For us speech pathologists, if you're an OT and want to add speech pathology, we have a heck of a lot more tests and materials. So, you know, it's a trade-off depending, but again, if you do an independent contractor, maybe they already have that stuff. you know, use it to see patients with you.

Aaron Marshall (11:46)
Hahaha!

That makes sense. ⁓ Yeah, so I guess if you're going to advise somebody who is exploring this and you're going to give them one piece of advice that's going to get them thinking in the right direction, set them up for success, what would that one piece of advice be?

Jennifer Voltz (12:19)
Save your money. ⁓ Have a built up capital because you're going to have hiccups along the way and things that you just didn't account for. So really, really having ⁓ a large savings account will help so that you confront the cost for these providers because of course somebody's not going to sit around and wait three months to get paid. It's a good way to lose people fast. So being able to pay them while you work out the kinks.

and recognizing that some of the time, you know, as a biller, you might do it wrong and you're out that money. So I would say give yourself a good cushion financially would be a big piece of advice.

Aaron Marshall (12:58)
That makes sense. And then just to jump off of that, I know a lot of folks get scared off because they say, well, I understand speech, but I don't understand OTMPT. And usually what they're saying there is they don't understand the billing side of it. So could you dispel a little bit of that myth around how complicated it is, one versus the other?

Jennifer Voltz (13:21)
It's not so bad, honestly. I don't think that it should scare people away. I think it's a great thing to offer in your community. Have all the different disciplines. ⁓ But again, just being humble and being able to admit you don't know some things and then reaching out for help and asking questions. ⁓ You know, like I said before, a great biller is great to know, to ask those questions. And then again,

the Alliance for Pediatric Therapies, I mean, it's been so great to reach out and ask a question, especially now with some of the things that are going on with the MMAs and partial denials and just saying, hey, I'm seeing this, are you seeing this? And then troubleshooting and problem solving just together, we're in this together. There's plenty of children to go around. There's no need to compete. It's not like I have some secrets that I'm not willing to share with people. think ⁓ learning from each other just so that we can help as many kids as possible is just the best attitude to have.

⁓ and being open and yeah.

Aaron Marshall (14:21)
That's a pretty good transition actually to your new role. Could you just tell us a little bit about what you're doing and what the Alliance for Pediatric Therapies is doing, you know, new this year or, you know, some of the initiatives that you're taking on?

Jennifer Voltz (14:36)
absolutely. I am super excited about it, to be really honest. ⁓ I have always loved what the Alliance for Pediatric Therapies stood for because as I grew my multidisciplinary practice, there's a lot of issues that are not just affecting speech pathology or just affecting occupational, ⁓ know, especially when it comes to the MMAs and Medicaid ⁓ and knowing what the rights are for our patients.

federal regulations and how insurances and MMAs just have to follow those rules because this is our taxpayer money going to support these services. So recognizing how we can best serve our patients and best provide for them. it's been a grassroots effort that has grown and grown. I'm really proud to be a part of it. I first joined in, think maybe 2014 or 2015 is when I joined.

I think that's how I met you, honestly, Erin, is probably through the Alliance and colleagues, because I think we're at different parts of the state, ⁓ you and I are, but that group, it really is a niche for private practice. And you might want to reach out to your professional association, but they're also working on school issues. And ⁓ Asha is looking at just speech pathology from a federal standpoint. ⁓

Aaron Marshall (15:34)
you, Cypher.

Jennifer Voltz (16:00)
in the Alliance for Pediatric Therapies are basically just a group of private practices. We revamped it totally. So we're really excited about that. There's about eight people on our board. ⁓ I was elected the president. It was very sweet. I did not feel like I was prepared, but I was grateful that they believed in me. ⁓ And I've been learning a lot of great things along the way, but we do a lot of lobbying and efforts down at the Capitol, making sure that our politicians understand our needs.

And we can tend to get together in a group and complain about a lot of things and validate each other. Yeah, that sucks. Oh, that's so hard. I didn't get paid for that either, man, oh man. But what we really need is action, right? So joining this group, we revamped it. So it used to be that if you wanted to join and you were a small practice, it was $500. And if you were a medium practice, it was more. And if you were a large practice, it could be as much as $1,500 a year.

Now we're down to $200, no matter the size of your practice. So you join, really easy to join on a link. And I can send out that link if you guys want. And so when you join, you now get access to the membership portal. And you will get ⁓ updates as we are working on projects and things that we're doing. And it's not just the Alliance for Pediatric Therapies. I'm also very closely involved with the consortium.

which is also another group of multidisciplinary professionals that are private practice owners. ⁓ And we work on these projects, for example, there's been a lot of partial denials. ⁓ Authorizations are a big part of our practice and ⁓ these denials have been coming at us and with reasons that we aren't all understanding and... ⁓

We have a great success story just recently that the consortium and the alliance worked together and we were able to compile a list of about 22 different cases of partial denials where they had different reasons. And we put all that together and we studied it and we looked at how that was affected by EPSDT, the federal regulations that protect children with Medicaid.

And we explained to the MMA that what you're doing here is against the law, essentially. And they listened to us and they said, okay, we're not gonna ask for IEPs anymore. ⁓ That is not a rationale that can be determining whether or not a child gets services. So it was a win. And know, money well spent and we're fighting together and our money is going towards that. So it's a great thing. If people wanna join that, I would really recommend it.

Aaron Marshall (18:44)
I actually can't say enough good things about the stuff that I've seen the Alliance and the consortium work on for private practices. And I think you made an important distinction there. You said, you know, like Flasha and Asha, they're focused on other things, are not always focused on private practice, but the Alliance for Pediatric Therapies, they're focused on the private practice. They're focused on, you know, my clients and, you know, folks that you work side by side with. So.

Jennifer Voltz (19:08)
Okay.

Aaron Marshall (19:11)
That's really the big difference. mean, definitely join your state organizations. Definitely join Blascia. They're hand in hand, side by side, working on these things. But you also have to be involved where you're making the most impact. And just to hear that you guys have dropped the cost to be able to allow more people in, I mean, that's great. We're going to take that link. We're going to put it in the description and make sure that everybody has that. And I guess that...

Jennifer Voltz (19:14)
Over.

Okay.

Aaron Marshall (19:40)
kind of leads me to the last question. So somebody

is listening to this and they're thinking, okay, yeah, I wanna get involved. What's the best way for them to do that?

Jennifer Voltz (19:49)
Get involved with the Alliance or get involved with multidisciplinary.

Aaron Marshall (19:54)
I would say with the Alliance, if they want to join you in the fight in the Alliance.

Jennifer Voltz (19:55)
Okay.

yes, definitely. So click on that link. It will give you some information about what the Alliance for Pediatric Therapies is all about in our mission statement and what we're doing. We are a nonprofit, so you would go ahead and join that group. And like I said, it's a $200 fee. You can pay it right there online. And then you get access to the membership. And when you become a member, check in with us. But now we have your contact information, your email, your text.

⁓ whatever way you feel like is the best way to connect and network with others. We're going to reach out to you. do happy hours together virtually, which is really fun. You grab a glass of wine or, or a diet Coke, if you like that. And, and, we sit down and we just say, Hey, what's up? What, what caused you to join? What are your needs? How can we all help each other? ⁓ we're definitely looking for people who want to get active. And the thing is, is I definitely was one of those people. I was like, I want to be involved, but I was

Aaron Marshall (20:37)
Yeah

Jennifer Voltz (20:53)
intimidated because I was like, I'm brand new at this. I don't know how to get involved. It doesn't matter. We just need your voice. We'll guide you. We'll tell you what our needs are. Maybe it's just a matter of give me a couple of examples of what you're dealing with and I can compile those with everybody across the state. And then our voice is going to be heard because it's not just one of us calling, you know, an MMA and complaining. It's now people across the entire state having the same issues, fighting for the same reasons, access to care. It's the biggest.

getting our kids the access to care so that we can stay in business and continue to help more and more children. yeah, get involved.

Aaron Marshall (21:27)
Yeah, Absolutely. It's

a very approachable organization with very humble people that are really just committed to making sure that the kids have the care that they need.

Jennifer Voltz (21:39)
Yeah, our colleagues are awesome. I love them. We have fun. We laugh. We enjoy each other. And then we have an annual conference coming up. I wanted to mention that.

Aaron Marshall (21:47)
⁓

Tell us about that real quick.

Jennifer Voltz (21:50)
Yeah, of course, so it's next month. So you gotta get involved quick here, but it is October 17th. If that's a Friday, don't quote me, but I believe it's the 17th. ⁓ It's Friday, it's in Orlando. We have a space that we were able to get through ⁓ the college there. And ⁓ we're gonna have representatives from the MMA is coming. We're gonna have representatives from OCA. We have our own founder Chris Snow who's going to be there and answer questions. ⁓ He has...

formed great relationships with a lot of politicians and he understands the workings and how just things change and how things get how things improve ⁓ You know politically to be able to help this access to care so that conference I went to it years ago. I learned so much. I got to meet great people. We'll have a lunch. We'll have drinks ⁓ So yeah, that's coming up next month. So you have to join I believe you have to be a member to go to the conference, but I can double-check on that

Aaron Marshall (22:43)
and tap.

Okay, now that sounds great and are you guys gonna do the conference once a year now? Move forward, is that what you're thinking?

Jennifer Voltz (22:54)
Yes, we're going get back to the annual conference. used to do it years ago. COVID hit, then it went to virtual and then that kind of, you know, got pushed aside with all these projects that were coming up. So we're going to make that a priority of, you know, regular conference, virtual calls, regular meetups, but then an annual in-person conference for sure.

Aaron Marshall (23:13)
I love it. Now is the time to get involved. The cost is dropping, the engagement is increasing. There's momentum. I feel like there's momentum across Florida. So Jennifer, I just really appreciate you joining us again and coming on here and telling us all about the new stuff and what's going on. So thank you so much.

Jennifer Voltz (23:17)
Yes!

Oh, my pleasure.

Thank you so much for having me. It's always a great time talking with you, so thank you.

Aaron Marshall (23:38)
All right, thank you for listening and we will talk to you again soon.

Jennifer Voltz (23:42)
Bye!