The ASHA Health Care Economics Committee (HCEC) met at the new national office Friday March 14 through Sunday March 16. Several members made Capitol Hill visits on Friday morning before the meeting began. A representative from CMS briefed the committee on changes to the Medicare Benefit Policy Manual regarding audiology coverage that will become effective April 1, 2008. Changes include clarification that vestibular testing, auditory processing evaluation, tinnitus evaluation, and diagnostic programming of audiology prosthetic devices are included as diagnostic testing for Medicare. It also clarifies that automated computer-administered hearing tests are screening tests and, therefore, are not covered. It also indicates that “a Doctor of Audiology (AuD) 4th year student with a provisional license from a State does not qualify unless he or she also holds a master’s or doctoral degree in audiology”. Also discussed were levels of supervision and how these relate to the use of neuropsychological codes.

Members of the ASHA Health Care Economics Advocacy Team discussed various issues with the committee, including a CCI edit that prohibits billing endoscopy and videostroboscopy on the same date of service, the National Quality Forum, and using different levels of service for a CPT code when negotiating with individual payors.

Wayne Holland, representative to the AMA CPT panel, updated the committee on the presentation AAO-HNS made to change the language in the introduction of the Special Otorhinolaryngological Services Section of the CPT Code Book. The changes were suggested to reflect current clinical usage. A new code for canalith repositioning was presented. The outcome of each of these presentations is not available at this time. Bob Fifer, representative to the RUC panel, updated the committee on collaboration on work surveys among the American Academy of Neurology, American Academy of Otoloryngology-Head & Neck Surgery, American Physical Therapy Association, American Chiropractic Association, American Academy of Audiology and ASHA on the proposed canalith repositioning code.

Bernie Patashnik, consultant to the committee, presented information on the future of Medicare and how the HCEC can respond to expected change. The committee discussed how our members might get more involved in the PQRI measures. Additionally, the need to gather information about how managed Medicare is affecting our services was considered because a greater percentage of Medicare beneficiaries are enrolling in managed Medicare plans. We also discussed the impact of Recovery Audit Contractors (RACs) on our members. Kathryn Phillips Campbell of the National Business Group on Health (NBGH) joined the committee by conference call to share information on the Employer’s Toolkit they developed on Investing in Maternal and Child Health. NBGH members are primarily Fortune 500 companies and large public sector employers.

The speech-language pathology subcommittee of the HCEC discussed coding questions received from members (e.g., how to code for FEES and evaluation for tracheotomy speaking valve) and the draft position statement on endoscopy. They decided to move forward with a proposed ICD-9-CM change to separate phonation and resonance. They continue to collaborate with Special Interest Division on Fluency and Fluency Disorders on proposed changes to where the codes concerning stuttering are located in the ICD-9-CM book. The goal is to present the proposals at the September meeting of the ICD-9 CM Coordination & Maintenance Committee. They continued the on-going discussion about ‘work’ for speech-language pathologists. Changes in reimbursement rates as a result of the elimination of the non-physician work pool put codes without ‘work’ (e.g. the SGD/AAC codes, clinical swallow and modified barium swallow codes) in line for significant reductions by 2010.

The audiology subcommittee discussed proposed codes for VNG and hopes to present this to the CPT Editorial Panel later this year. They are also investigating developing an audiology evaluation code to be used when a patient is seen by an audiologist only (and not an otolaryngologist) to cover the pre and post service activities (e.g., taking case history, counseling results, etc). A future code proposal under consideration is the supplemental speech recognition test. The sub-committee reviewed a HCPCS proposal from the VA and endorsed it.

After hearing an update on the Strategic Pathway to Excellence from Steve White, ex officio, the committee updated the HCEC’s 2008-2009 Strategic Plan. Major categories of activities in the plan include: Education of Members; CPT Code Development; ICD Code Development; Professional Component; Trends; and Collaboration and Consultation.

The members of the HCEC are:

Questions about this report may be directed to: swhite@asha.org or nswigert@aol.com.

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 21, 2008 that would update payment rates for services furnished to Medicare patients in inpatient rehabilitation facilities (IRFs), effective for discharges on or after October 1, 2008. The proposed rule would apply to more than 200 freestanding IRFs, and to more than 1,000 IRF units in acute care hospitals.

In order to be excluded from the acute care hospital payment system and instead be paid the higher rates for providing rehabilitation services as an IRF, the facility must demonstrate that its annual patient population consists of at least 60 percent of patients with one or more of the qualifying conditions listed below. The 60 percent threshold, as opposed to 75 percent, is a major modification mandated by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). The law also requires CMS to continue the use of specified comorbidities (i.e., secondary diagnoses) in addition to the patient’s primary reason for being in the IRF when determining the 60 percent compliance level.

Speech-language pathologists employed in IRFs may be disappointed that the MMSEA does not allow payment increases in FY2008 or FY2009. However, the diminished restrictions on patient diagnoses allow IRFs to admit patients that may have been denied under the 75 percent rule.

As always, cases with extraordinarily high costs compared to the prospectively set payment may qualify for an outlier payment. However, due to the statutory elimination of FY2008/ FY2009 payment increases, CMS calculated a need to reduce estimated outlier payments from 3.3 percent for FY2008 to 3.0 percent for FY2009. This proposed change will result in an estimated decrease in aggregate IRF payments of $20 million for FY2009.

Conditions that qualify for the 60 percent rule: Patients who have one or more of the following conditions as the primary reason for receiving treatment in the IRF or as a qualifying comorbidity may be counted toward an IRF compliance percentage.

* Stroke
* Spinal cord injury
* Congenital deformity
* Amputation
* Major multiple trauma
* Fracture of femur (hip fracture)
* Brain injury
* Neurological disorders
* Burns
* Arthritis-related medical conditions (three types specified in the rule)
* Knee or hip joint replacement if (1) it was bilateral, (2) the patient’s BMI was greater than 50, or (3) the patient was 85 or older

Comments will be accepted on the proposed rule until June 20, 2008 and CMS will respond to comments in a final rule to be issued on or before August 1. The complete proposed rule is found at www.cms.hhs.gov/InpatientRehabFacPPS/LIRFF/itemdetail.asp?itemID=CMS1209922. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, at mkander@asha.org or by phone at 800-498-2071, ext. 5669.

4/16/08: CMS Extends Deadline for Use of Audiology NPI by Physician Practices

 The Centers for Medicare and Medicaid Services (CMS) announced that audiologists will have until October 1, 2008 to obtain their National Provider Identifier (NPI) and Medicare provider number when billing from a physician’s office. As part of revisions to Medicare’s audiology coverage policies, CMS determined that audiology services are not covered as incident to physician services.  This policy shift will now require audiologists to use their own NPI when billing for Medicare services from a physician office.

For additional information on CMS changes to audiology services, please go to http://www.asha.org/members/issues/reimbursement/medicare/audpolicyupdate.htm.  ASHA received numerous phone calls from audiologists concerned that they do not have adequate time to apply for and receive an NPI.  ASHA worked with CMS to extend the date by which audiologists can to comply with the new policy requirements.  CMS will require the use of the NPI on claims for diagnostic test services furnished by audiologists on or after October 1, 2008.  Audiologists are encouraged to obtain an NPI and enroll as soon as possible.  Audiologists can learn more about obtaining an NPI at: http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp#TopOfPage. Enrollment forms are located on the CMS website at http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplications.asp.

4/14/08: Recently, a few ASHA members who are listed on ProSearch have been targeted by an email check cashing scam asking for services and then, once contact is made, for money. Beware. 

The authorities have been alerted to this scam and they are investigating.  ASHA’s Web Site and ProSearch page are secure and very few ASHA ProSearch members have contacted us about this scam. But, if you receive an email similar to the one below, please ignore it. If you have questions or concerns, please contact ASHA’s Action Center at either actioncenter@asha.org or 800-498-2071.

Hello,
I am John Lauren . I saw your contact on www.asha.org .  Anyway, I am an English speaking man from Cotonou I will be  coming over to the US, Pelham, AL, precisely, from the 6th of April to 17th of May with my wife and our 4 year old Daughter. They both speak English as well.

While we will be in the US , we will want to see a someone who can help Betty( our daughter) with her speech as she stutters and it's really giving us concern particularly since it's not hereditary and no one in our families stutters. I will want to know if you can provide your services between these dates. Please let me know.

If you will be available, I'll want to know if you offer home visits , I will also appreciate if I can get a price quotation, as we want to make advance payments before our visit so my wife can be rest assured as she'll be doing a lot of shopping and sightseeing as this is her first visit to the US An early response will be appreciated. Hope to hear from you soon.

John

4/14/08: ASHA Schools 2008 - Power in Partnership

July 25-27
Disney's Contemporary Resort
Walt Disney World, Florida

An outstanding conference in an outstanding location! The program is packed with topics of interest to school-based professionals: autism spectrum disorders, selective mutism, auditory-linguistic processing disorders, response to intervention, and supervision—to mention just a few.

And, we've arranged a special rate at Disney's Contemporary Resort for ASHA Schools attendees, plus discount ticket packages not available to the general public. All the information you need is on the Web. Sign up now!

P.S. The number of rooms at the special ASHA rate is limited. Make your reservation early to ensure the lowest rate!