Dept. of Education Rules for SLP Stipend

Click the link in blue below to access the new SLP Rules and Regulations for payment of the Salary Supplement Stipend as enacted by Act 607 of 2009.  We have been separated from the Rules we saw in October. These Rules will be presented to the State Board of Education on March 8 at 9 a.m. Beverly Williams, Associate Commissioner, will present the Rules and Regulations to the State Board of Education with the recommendation that they go out for public comment. The following is listed as Action 12 on the Agenda for Monday's meeting.

A-12 Consideration for Public Comment: Rules Governing Eligibility and Financial Incentives for Certified Speech-Language Pathologists

The Rules Governing Eligibility and Financial Incentives for Certified Speech Language Pathologsts who hold Certificate of Clinical Competence in Speech-Language Pathology from the American Speech -Language- Hearing Association have been separated from the National Board for Professional Teaching Standards Rules governing bonus incentives. This split is pursuant to public comments therefore these new rules are being released for public comment.

Please join members of ArkSHA during the meeting on Monday, March 8th. Let us show our support of these Rules, as we move forward.

ArkSHA knows we already did this in October; however, it has to be done again. ADE officials have informed ArkSHA that because the appropriations is now a standalone rule, it has to go out for public comment to comply with the Arkansas Administrative Procedure Act. It is for that reason that it is being presented again.

Carol B. Fleming, M.S., CCC-SLP
ArkSHA President

cbflem@swbell.net

Professional Issues in Telepractice/Telespeech for Speech-Language Pathologists

The draft document Professional Issues in Telepractice/Telespeech for Speech-Language Pathologists is now available for peer review until February 5. It was developed by the Ad Hoc Committee on Telepractice in Speech-Language Pathology. This document provides updated information about telepractice in terms of technology, quality, clinical practice, licensure, and credentialing, but does not replace the existing telepractice documents from 2005.

Please go to the ASHA Web site http://www.asha.org/peer-review/peer_reviews.htm to read the document and complete the online peer review form.

Thank you!

Ad Hoc Committee: Pauline Mashima (chair), David Brennan, Michael Campbell, Diana Christiana, Vickie Pullins, and Janet Brown (ex officio). Monitoring Vice President: Julie Noel.

 Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, ASHA Fellow

Chief Staff Officer, Speech-Language Pathology

American Speech-Language-Hearing Association

New Audiology CPT Category III Codes

There are five new Current Procedural Terminology (CPT^[i]) Category III codes related to audiometry that became effective on January 1, 2010. Audiologists routinely report CPT codes for billing clinical services, but the CPT codes audiologists know the best are Category I codes. These codes, such as 92557, must meet the following CPT Category I requirements:

·         Services or procedures are performed by many health care professionals across the country

·         FDA approval is documented or imminent with a given CPT cycle

·         The service or procedure has a proven clinical efficacy

·         The service or procedure has relevance for research, either ongoing or planned

In contrast, Category III codes are “a set of temporary codes for emerging technology, services, and procedures” assigned an alphanumeric identifier with a letter in the last character. The five new audiometric codes are not in the 2010 CPT Codebook but became effective on January 1, 2010. They are:

·         0208T Pure tone audiometry (threshold), automated; air only

·         0209T    air and bone

·         0210T Speech audiometry threshold, automated;

·         0211T    with speech recognition

·         0212T Comprehensive audiometry threshold evaluation and speech recognition (0209T, 0211T combined), automated

In a follow-up rationale to the American Medical Association (AMA), automated was distinguished from computer assisted. Audiologists use many computer assisted devices for procedures such as otoacoustic emissions and evoked potentials. The use of these devices requires the constant presence and vigilance of the audiologist to ensure appropriate data gathering for test interpretation. In contrast, automated refers to equipment intended to be used without ongoing monitoring and vigilance whereby the equipment follows a specified algorithm to determine what action to take next.

Audiologists should report these new Category III codes when automated audiometry is performed. Of course, for manual audiometric testing by an audiologist or physician, 92551-92557 should be used. Bekesy audiometry codes 92560 and 92561 are also available when appropriate. According to the AMA, the “assignment of a CPT Category III code to a service does not indicate that it is experimental or of limited utility, but only that the service or technology is new and is being tracked for data collection.” The AMA points out that, “in the Final Rule for the 2002 Medicare Physician Fee Schedule (Federal Register, Thursday, November 1, 2001), the Centers for Medicare and Medicaid Services (CMS) stated that they believed that Category III codes ‘will serve a useful purpose’ and that payment for the service is at the discretion of the Carriers, but that the codes could be paid after entered into the computer systems.” 

Please contact reimbursement@asha.org with questions or comments.

Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, ASHA Fellow

Chief Staff Officer, Speech-Language Pathology

American Speech-Language-Hearing Association

Audiology PQRI Frequently Asked Questions Available

Audiologists have the opportunity to improve both the profession of audiology and quality of care provided to patients by participating in the Medicare Physician Quality Reporting Initiative (PQRI) program. The Audiology Quality Consortium (AQC) has created a list of Frequently Asked Questions for audiologists who are enrolled as a Medicare provider and are interested in learning more about the PQRI program. PQRI is a voluntary program designed to improve the quality of care to Medicare beneficiaries. Beginning on January 1, 2010, audiologists that bill Medicare Part B and participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment.

This is the first in a series of PQRI informational resources for audiologists that will be published in November by the AQC. Next week’s topic: What are the audiology measures and how to use them. For further information, please contact Kate Romanow, ASHA’s Director of Health Care Regulatory Advocacy, at kromanow@asha.org or 800-498-2071, ext. 5671; or Anne Oyler, ASHA’s Associate Director of Audiology Professional Practices, at aoyler@asha.org or 800-498-2071, ext. 5791.

CMS Releases 2010 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) have published the 2010 Medicare Physician Fee Schedule (MPFS). Should Congress not intervene by year’s end, a dramatic decrease would occur in the conversion factor from the current $36.0666 to $28.4061 – a 21.2% reduction. The House is expected to take up H.R. 3961, the "Medicare Physician Payment Reform Act of 2009," during the week of November 16, which would repeal the sustainable growth rate (SGR) physician payment formula and replace it with a new payment update system, including a 0.5% increase for 2010.

The conversion factor (CF) is linked to the SGR which is a legislatively mandated formula intended to control the growth of Medicare Part B expenditures. If expenditures exceed the SGR target, the MPFS update is reduced. The SGR is a product of changes in total fee payments, enrolled beneficiaries, per capita growth in the gross domestic product, and an estimate of expenditures caused by changes in laws and regulations. In the past, Congress has given one year reprieves to the SGR reduction.

The table below provides four examples of the 2010 fees with the 21.2% reduction in the SGR and fees that reflect the 0.5% proposed increase for the Medicare fee schedule. The total relative value units (RVUs) have increased for some procedures and will become apparent in improved fees if Congress resolves the SGR issue for 2010.

Some reduction in payment for audiology and speech-language pathology procedures is due to the phased in reduction of the technical component (TC) values. The increase in the professional component offsets some of the TC reductions for 2010. Specific changes to speech-language pathology and audiology procedures are also found in the 2010 fee schedule. During 2009, four speech-language pathology procedures were revalued and three new audiology codes were valued by the American Medical Association (AMA) Specialty Society Relative Value Scale Update Committee (RUC). All of the procedures reflect the SLP’s or audiologist’s services in the professional component (physician work) rather than the technical component (practice expense) as had been done in the past. ASHA and other professional societies successfully presented recommendations for the professional components to the RUC in 2009.

CMS accepted the RUC’s recommendations for all but one procedure – 92597 voice prosthetic device evaluation. CMS maintains that the initial fitting of the device is included with a code reported by the physician 31611 (construction of tracheosesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis). Consequently, CMS reduced the professional component RVU from 1.48 to 1.26. The work RVU values for the other three procedures are now 1.34 for 92526 (swallowing dysfunction treatment), 1.30 for 92610 (clinical swallow evaluation), and 1.34 for 92611 (MBS).

RUC professional component values were accepted for the three new audiology bundled procedure codes (i.e., combination of single procedure codes into a single code). They have 2010 professional component values of 1.50 for 92540 (basic vestibular evaluation), 0.35 for 92550 (tympanometry and reflex threshold measurements), and 0.55 for 92570 (acoustic immittance testing).

Another important development for audiology pertains to five timed codes for which CMS accepted the professional component RVUs for 2009:

• 92620 (Evaluation of central auditory function, with report; initial 60 minutes);

• 92621 (Evaluation of central auditory function, with report; each additional 15 minutes);

• 92626 (Evaluation of auditory rehabilitation status; first hour);

• 92627 (Evaluation of auditory rehabilitation status; each additional 15 minutes (List separately in addition to code for primary procedure); and

• 92640 (Diagnostic analysis with programming of auditory brainstem implant, per hour).

CMS will not pay for any “therapeutic activities or activities that should be billed as E/M (evaluation and management) services associated with these audiology codes...because they do not fall within the benefit category under which these tests are covered.” Technical component (practice expense) values for the above timed procedures were reduced because the audiologist’s time is no longer a factor in this component.

The Medicare combined speech-language pathology and physical therapy cap will be $1,860 for 2010. Like the SGR reprieve, the current exceptions process for the cap will expire at the end of 2009 unless Congress acts to extend it. A two-year extension to the exceptions process has been included in both the Senate and House health care reform bills under consideration.

A complete analysis of the 2010 Medicare Physician Fee Schedule will be posted on the ASHA Web site in the near future. For further information or questions about the Medicare fee schedule, please contact reimbursement@asha.org.

Identity Theft Prevention Delayed Until June 1, 2010

The Federal Trade Commission (FTC) has again pushed back the implementation date for the “Red Flag” rules from November 1, 2009 to June 1, 2010. The FTC requires health care providers to implement a policy to prevent identity theft. Private practice audiologists and speech-language pathologists who do not require patients to pay for their services in full at the time of service are required to implement a program to prevent identity theft by June 1, 2010.  The FTC’s announcement can be found at http://www2.ftc.gov/opa/2009/10/redflags.shtm. ASHA’s article about complying with the FTC’s “red flag” rules can be found at http://www.asha.org/publications/leader/archives/2009/090714/090714b.htm. For further information, contact Kate Romanow, ASHA's Director of Health Care Regulatory Advocacy, at kromanow@asha.org or 800-498-2071, ext. 5671.

ICD-9-CM Voice and Resonance Codes Revised Starting in October 2009

There will be new and revised diagnostic codes for voice and resonance disorders beginning on October 1, 2009. The National Center for Health Statistics (NCHS) of the U.S. Department of Health and Human Services Centers for Disease Control and Prevention coordinates and maintains the disease and disorder codes for the International Classification of Diseases, 9^th Revision, Clinical Modification. NCHS recently posted the ICD-9-CM Tabular Addenda that goes into effect for fiscal year 2010 (October 1, 2009).

ASHA presented a proposal for the revision and expansion of codes to the ICD-9-CM Coordination and Maintenance Committee on March 12, 2009. As the result of the work of Dee Adams Nikjeh of the ASHA Health Care Economics Committee and Special Interest Division 3, the 784.4 series is modified from “voice disturbance” to “voice and resonance disorders” and will be as follows:

784.4 Voice and resonance disorders

784.40 Voice and resonance disorder, unspecified (revised)

784.41 Aphonia, Loss of voice

784.42 Dysphonia (new code), Hoarseness

784.43 Hypernasality (new code)

784.44 Hyponasality (new code)

784.49 Other voice and resonance disorders (revised)

NCHS expanded the 784.5 series to read as:

784.5 Other speech disturbance

Excludes: speech disorder due to late effect of cerebrovascular accident (438-10 – 438.19)

(added)

784.51 Dysarthria (new code)

Excludes: dysarthria due to late effect of cerebrovascular accident (438.13)

784.59 Other speech disturbance (new code)

Dysphasia

Slurred speech

Speech disturbance NOS (not otherwise specified)

Please visit the NCHS Web site to view the ICD-9-CM Tabular Addenda October 1, 2009 (FY2010). The Centers for Medicare and Medicaid Services (CMS) also recently published ICD-10-CM/PCS Myths & Facts to respond to questions regarding the ICD-10-Clinical Modification/Procedure Coding System. For questions or further information, please contact Steven White, ASHA’s Director of Health Care Economics and Advocacy, at swhite@asha.org.