Reimbursement Support Coalition Survey

Your State Advocate for Reimbursement (STAR) liaison between ASHA and WSLHA, is inviting members to participate in the newly formed Reimbursement Support Coalition.  This project is the result of an ASHA grant and is intended to bring support to SLPs and As in Washington who are serving in management roles in private practice or clinical settings.  Starting this summer, bimonthly conference calls will be held to discuss topics of reimbursement trends, coding/billing, and strategies for appeals.  This survey link below will help identify the issues that are most important and current to us in Washington and develop agendas for these calls.  Regardless if you are able to participate in the conference calls, your input is valuable so please complete the survey.  If you would like to be notified of the first conference call date and time along with instructions for dialing in please email Dana at capslp@turbotek.net  The results of the survey will be presented in the first call.

Click on the link below to take this brief survey.

https://www.surveymonkey.com/s/FBGL6K3

 

VSA Washington, one half of our arts partnership, is the State affiliate of VSA International – a U.S. non-profit affiliated with the Kennedy Center for the Performing Arts in D.C. It is now in jeopardy due to current budget action in Congress. YOU CAN MAKE A DIFFERENCE!

Founded in 1974 by Ambassador Jean Kennedy Smith,VSA serves individuals of all ages with disabilities, but most particularly school-aged students eligible to participate in special education, preferably in inclusive classrooms. The programs developed by VSA are tested, replicated, revised, and perfected through the network of state affiliates. State and district affiliates develop unique programs that reflect the interests and resources of given schools and communities. 

Here in WA State, VSA supports teacher training, artist residencies, and ArtSpring! – and annual, inclusive arts festival serving hundreds of K-12 students and their teachers each year.  With our schools cutting budgets so drastically, these VSA-funded programs are providing vital arts services to our children – where otherwise there might be no arts at all.

 VSA funding has been cut – along with Kennedy Center Education funding – in the recent budget deal worked out in Congress.  We must ACT NOW to restore funding levels to an amount level with 2010 funding.  Please take a moment NOW to write Senators Murray and Cantwell (see side bar for links).  We have provided some additional facts below, for your information and use.

 We encourage you to add your personal stories!  How have arts programs impacted your children – your students – yourself?  Your voice really CAN make a difference – please take time to be heard TODAY!

 Thank you,

~Deborah Witmer,Executive Director, Creative Activities/VSA Washington

Additional Information:

 VSA has enjoyed bi-partisan support from the Congress for the past 27 years.  For every $1 of federal money received, VSA raises up to $7 from local and private sources in individual states, through the efforts of the national office and the 50-state affiliate and partner network it serves and supports. VSA receives directed federal funding because of its stature as a program of national significance. As a result of the longstanding federal investment in VSA, a strong national and diverse network of programs that make the arts accessible to individuals with disabilities has been created and is sustained by this critical support. Over 7 million people participate in VSA programming around the world.

 The Arts in Education program at the Department of Education provides funding for VSA and the John F. Kennedy Center for the Performing Arts, in addition to funding for model arts collaborations with schools, professional development for arts educators, evaluation and dissemination programs, and arts programs for at-risk youth. This year, Congress has targeted the Arts in Education program to be eliminated because under current Congressional Rules, any authorized program, which includes Arts in Education, is considered an earmark. Even though this is a nationwide program voted on by the entire Congress and not one single member’s “pet project” funding for this program is under serious threat.

 Research shows that a complete arts education, including dance, music, and drama, contributes to improved academic performance – particularly for students with disabilities. VSA programs provide students with valuable academic advantages and teachers with research-based, innovative strategies to ensure participation and progress for each student by using the arts to enhance the learning process.

Invitation to a Public Meeting during the Site Visit of ASHA’s Council on Academic Accreditation

 PUBLIC NOTICE

Invitation to a Public Meeting during the Site Visit of the Council on Academic Accreditation (CAA) of the American Speech-Language-Hearing Association

 Friday, April 1, 2011; 11:00 am – 12:00 pm

Health Sciences Building, Room 110A

Riverpoint Campus

The Department of Communication Disorders at Eastern Washington University invites all interested parties (e.g., clinic clients, clinic supervisors, current and former students, members of EWU’s academic community, and members of the general community) to a Public Meeting during its upcoming accreditation site visit. The Public Meeting will be held from 11:00 am until 12:00 noon on Friday, April 1, in Room 110A of the Health Sciences Building on the Riverpoint Campus. Attendees will have the opportunity to meet with members of the accreditation site visit team to provide personal observations and experiences related to the graduate program’s compliance with the CAA’s accreditation standards.

 

Interested parties may either attend this meeting to provide oral or written testimony to the Site Visit Team, or may provide comments to the Council on Academic Accreditation prior to the site visit. Written comments provided prior to the site visit must be submitted to the Council on Academic Accreditation no later than Wednesday, March 16. All written testimony must include the commentor’s name, address, telephone number, and the commentor’s relationship to EWU’s Department of Communication Disorders. All written comments must be signed and submitted to:

 Accreditation Public Comment

Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA)

American Speech-Language-Hearing Association

2200 Research Blvd., #310

Rockville, MD 20850

 

Written comments can also be faxed (301-296-8570) or emailed (accreditation@asha.org) to the CAA.

 A copy of the CAA’s Standards for Accreditation and Policy on Public Comments can be obtained by contacting the Accreditation Office at the address above, by calling ASHA’s Action Center at 800-498-2071, or by accessing these documents online at:

http://www.asha.org/academic/accreditation/accredmanual/section3.htm and http://www.asha.org/uploadedFiles/academic/accreditation/PublicComment05.pdf.

Interested parties may also contact Donald R. Fuller, chair of the Department of Communication Disorders, for more information (phone: 509-828-1378; email: dfuller@ewu.edu).

ASHA requests information regarding denials.

ASHA is preparing for advocacy for federal employees. It is particularly useful to have actual denials and ASHA would welcome any denials that you have for clients who have been served under the Federal Employee’s Plan, TriCare, and/or the VA. Keep in mind that the Federal Employee has many choices for insurance, so it’s a matter of knowing the client, and whether they’re receiving coverage through a Federal Plan. Thanks for your assistance. You can fax denials to Laurie Alban Havens at 301-296-8577. She has also asked that we send her an email so she’ll know to expect it. Laurie Alban Havens Director, Private Health Plans and Medicaid Advocacy American Speech-Language-Hearing Association (ASHA) 2200 Research Boulevard #220 Rockville, MD 20850 Direct Line: 301-296-5677 Fax: 301-296-8577 National Office: 301-296-5700 lalbanhavens@asha.org http://www.asha.org

WSHA Member Feedback Requested re: Name Change Proposal

To Our Esteemed WSHA Members & Friends:

This is to advise you that the Washington Speech & Hearing Association Board of Directors are presenting a special ballot to the members next month via MemberClicks.  

On the ballot, would be a request for your consideration of an official name change of the association from the “Washington Speech & Hearing Association” to the “Washington Speech-Language-Hearing Association (WSLHA).” 

This change would bring several benefits:  

(1) bring our official name consistent with our website address www.wslha.org (therefore easier to remember the address),

(2) the association name would also be consistent with our national association the American Speech-Language-Hearing Association (ASHA), and (3) recognize that we also treat language disorders in our profession.  

At this time, there is no known detriment to changing the name of the association.  Since most of our transactions and correspondence are done online and via email, there would not be a huge cost for printing since we could transition the new name and logo as supplies run out.

We would continue to be able to do business as “WSHA,” but all our official documents would be under the new proposed name (Washington Speech-Language-Hearing Association). 

The board is opening a “comment” or “feedback” period from January 25th to February 25th for all members and the general public.

Please send any comments, thoughts, feedback to my email address below or send it to the WSHA office and request that it be forwarded to me anonymously.

In addition, during this period, we are accepting submissions of a new association logo from the members. This, of course, would not become official until the members and ASHA have approved the name change. Depending on the number of responses, the logo request period may be lengthened.  The top three logos selected by board and committee chairs will be presented for member consideration.  A small prize will be awarded to the person submitting the final logo selected.   

Thank you in advance for your time and careful consideration!

Sincerely,

Elizabeth Martinez Braun
WSHA Board, Member At Large

Please email me at embraunwslha@gmail.com or office@wslha.org (for anonymous comments)

Tricare and Cognitive Rehabilitation

One of the topics that the STARs (ASHA State Advocates for Reimbursement) discussed during a recent conference call was TriCare and their decision not to cover cognitive rehabilitation for veterans.   Two related stories about this very subject have been in the recent news. Bernie Marcus, a philanthropist and former owner of Home Depot has a program in which he sponsors veterans who cannot get cognitive rehabilitation because of TriCare. See http://blogosaurusstampede.com/bernie-marcus-the-philanthropist-fills-in-where-tricare-refuses-to-go and http://www.npr.org/2010/12/21/132203864/philanthropist-provides-care-that-the-pentagon-wont.  The WTOP story concluded with an interview with someone who said that TriCare’s decision was based on one report but is in opposition to his review of outcomes data.

NAA Update on the Case of Ruby McDonough

The NAA  would like to share information about this precedent setting case in MA.  We are proud to have been involved from the onset and invited to sign on as an “Amicae Curiae” in the amicus brief filed by the National Disability Rights Network (NDRN) in the McDonough appeal.

 An “amicus brief” is a document filed in a case by someone who is not a party to the case but is interested in the outcome. National organizations sometimes file an amicus brief in a case that has the potentially of having an impact on other persons who are similarly situated to one of the parties to the case. It is an opportunity to inform the court about broad policy issues that it might consider in deciding the case.

 This case involves a crime victim who was denied an opportunity to have the crime prosecuted due to a communication disability that the court failed to accommodate. Other crime victims with communication disabilities in Massachusetts might be affected by the result in this case, and more broadly courts in other states might be influenced by the outcome. Given the potentially broad impact that this case might have on other crime victims with communication issues, an amicus brief is an important vehicle for informing the court about reasonable accommodations that courts can provide which make it possible for individuals to testify despite their disabilities.

 Through  the unwavering commitment of her attorney, Wendy J. Murphy, and the support of NAA friends including Jerry Kaplan and Paul and Judy Dane, Ms. McDonough has retained her rights. This has ensured that disabled crime victims are entitled to accommodations to ensure their equal access to Justice in criminal cases.  In particular, this is a strong, positive step in advocacy for the more than 1 million Americans living with aphasia.

 The NAA thanks all those involved especially Ms. Murphy and NAA President Emeritus, Alan Bandler.

 Below is Ms. Murphy’s summary of the events of the case for your information:

Earlier this month, Ruby McDonough was in a Massachusetts court fighting for her rights as a crime victim with a disability.  Ruby, who has aphasia, was sexually assaulted in 2009 by a male nurse’s aide at the nursing home where she has lived since suffering a stroke more than ten years ago.

 As with many aphasic persons, Ruby has trouble communicating in narrative style.  But she had no trouble telling her family, the staff and the police exactly what happened.

 The man accused of violating Ruby was charged with sexually assaulting Ruby in early 2009.  During pretrial proceedings his attorney asked that Ruby be subjected to a competency hearing. A court-appointed expert evaluated Ruby and found her to be mentally competent, though noted that she would need accommodations to help her communicate at trial, such as being allowed to answer in yes and no fashion, use gestures and images, and being allowed sufficient time to reply when more of a narrative was necessary.

 The court did not allow ANY accommodations, and Ruby was made to testify at her own competency hearing without any help.  Thus, when defense counsel asked things like “tell us what happened”, Ruby struggled.  At one point, defense counsel stood between Ruby and the perpetrator and asked whether Ruby could “see” the man who abused her.  Clearly use of the word “see” in such circumstances is unfair, and a fully abled person could simply have responded, “no, I can’t SEE him because you’re blocking my view” – but he is right there behind you”.  Ruby knew the attorney was trying to trick her, so she became frustrated and emotional.  The court ultimately found her not competent to testify.

 This is when I became involved as Ruby’s private attorney.  A lawyer from the Victims’ Rights Law Center had been assigned to represent Ruby at the competency hearing, but that attorney filed no pleadings, objected to nothing that occurred during the hearing and never once argued that Ruby’s rights under the Americans With Disabilities Act were being violated by the court’s refusal to afford Ruby any accommodations.  Some advocacy groups as a matter of policy refuse to aggressively represent the interests of crime victims, which is why it is critically important for a victim to ask around and to get feedback before agreeing to utilize the legal services of certain “victims’ rights” groups.

 I filed a special appeal for Ruby to the Massachusetts Supreme Judicial Court, arguing that Ruby’s rights under the ADA had been violated, and that the violation caused her to be illegally adjudicated incompetent.  After a hard fought battle during which the prosecutor and defense both opposed our effort, we finally prevailed in August, 2010.  The court not only ruled that Ruby’s rights had been violated, it established brand new rules to ensure that the rights of all disabled crime victims will be better protected.  The landmark decision was a first of its kind court ruling and makes clear that persons with disabilities not only have a right to things like wheelchair ramps to ensure they get IN to the courthouse, they have a right to accommodations that will enable their “full and equal” testimonial and participatory rights as WITNESSES in criminal cases.  Given that persons with disabilities are disproportionately victimized by criminal violence, in part because perpetrators anticipate they will not be held accountable – especially if the victim has a communication disability – this new court ruling means that many more victims will be allowed to testify and criminals will be better deterred from selecting vulnerable individuals to be their victims.

 After announcing its new decision, the Supreme Judicial Court sent the case back to the trial court where Ruby’s rights had been violated.  When we went back to the trial court in October, we expected the judge to rule that Ruby would now be allowed to testify, but instead the judge announced that Ruby would have no such opportunity because the perpetrator, an illegal immigrant, had been sent to Miami for immediate deportation.  The judge also refused to simply reverse the illegal ruling that had labeled Ruby “incompetent”.

 I decided to file another appeal to the state supreme court, after which we went back again to the trial judge in November, hoping that this time the perpetrator would be present so that Ruby could have her day in court.

 To our delight, the perpetrator showed up, and the judge completely changed his attitude, finally acknowledging not only that Ruby was entitled to all sorts of accommodations, but also that she would indeed be allowed to testify at trial.  The judge essentially ruled that because the basis for the earlier decision on competency had failed to recognize Ruby’s capacity to testify with accommodations, she had a right to take the stand at trial and utilize all reasonable accommodations to facilitate her communications as a witness against her assailant.

 The trial date is now set for January 12, 2011.

 Needless to say, Ruby is very excited that her dignity has been restored and her voice will be heard.  Win or lose, Ruby’s strength and perseverance in this case have helped ensure equal justice for all persons with disabilities.

 We are grateful that members of the aphasia community were in court with Ruby during the last two court hearings.  We hope to see support for Ruby again on January 12.

 The aphasia community has been extremely helpful in more ways than I can say in this brief summary.

 Thank you – and Happy Holidays.

 Wendy Murphy

Audiology Services – CMS Issues 2011 Medicare Outpatient Hospital Rates

The Centers for Medicare and Medicaid Services (CMS) released rates on November 2, 2010, for services in hospital-based outpatient departments in 2011. The Medicare Hospital Outpatient Prospective Payment System (OPPS) establishes payment rates for most services except speech-language pathology, physical therapy, and occupational therapy. Therapy services are paid under the Medicare Physician Fee Schedule.

 Following is a summary of audiology rate changes:

  •  Cochlear implant follow-up/reprogramming +13.7%
  • Evaluation of auditory rehabilitation status +13.7%
  • Stenger test; Spondaic word test +13.7%
  • Basic vestibular evaluation (bundled) +0%
  • Independent vestibular function tests +0 – 3.5%.
  • Comprehensive ABR and Electrocochleography +2.9%
  • EOE, comprehensive and limited +0% and 3.5%, respectively
  • Other audiometric tests +2.4 – 3.5%

 Cochlear implantation

CMS has increased the payment level from $28,906 to $31,060, an increase of 7.4%. The payment is intended to cover the device and non-physician surgical costs. Audiologists and others involved with cochlear implants are pleased that the 2011 rate will help retain hospital centers that offer this service.

Auditory Osseointegrated Devices (Baha)

The payment has been increased to $8,596, a 7.4% enhancement. This level is in contrast to $7,068 for ambulatory surgical centers (ASCs). ASHA has emphasized to CMS that the rate for this implant should be increased in ASCs in order to cover the facility costs and attract more cases to this setting with superior cost efficiencies.

For further information, please contact Reimbursement@asha.org.

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

Chief Staff Officer, Speech-Language Pathology

American Speech-Language-Hearing Association

2200 Research Boulevard, #229

Rockville, MD  20850-3289

+1 301-296-5705 telephone

301-296-8577 fax

lmcneilly@asha.org

CMS Issues 2011 Medicare Physician Fee Schedule with Audiology PQRI Incentive Payments

On Tuesday, November 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2011 Medicare Physician Fee Schedule (MPFS). Each year CMS establishes a conversion factor (CF) that is used as a multiplier of the total relative value units (RVUs) for each procedure. The current CF is $36.8729. Unless Congress acts, the CF is scheduled to be reduced to $28.4061, effective December 1, 2010, and $25.5217, effective January 1, 2011. This would represent about a 30 percent reduction from current payments and would affect all payments under the physician fee schedule. These reductions are due to the application of a statutory formula known as the Sustainable Growth Rate.  Please note that there is every indication that Congress will enact legislation to prevent these reductions from occurring. 

CPT 2011 Rates (without Congressional Action) Current 2010 Rates
(thru 11/30)
% Rate Change
92540 Basic vestibular evaluation $72.99 $96.98 -24.73%
92557 Comprehensive hearing test $30.37 $41.30 -26.46%

 CMS will continue the current audiology Physician Quality Reporting Initiative (PQRI) measures through 2011. The three audiology measures are referral for otologic evaluation for patients with: congenital or traumatic deformity of the ear; history of active drainage from the ear within the previous 90 days; and a history of sudden or rapidly progressive hearing loss.

 For 2010, the incentive payment for satisfactorily reporting on measures is 2% of all allowable Medicare charges. The final rule affirms the incentive payment structure set out in the Affordable Care Act (ACA):  an incentive payment of 1% for 2011 and .5% for 2012-2014. Starting in 2015, eligible professionals that do not satisfactorily report on quality measures will be subject to a payment adjustment.

 The audiology measures are reported via claims. Currently, providers participating in PQRI need to report on 80% of patients that fit into a measure. Effective January 1, 2011, providers reporting on claims-based measures will only need to report on 50% of patients that fit into a measure.

 Also of interest to audiologists is mention of screening of hearing impairment in older adults as part of the Health Risk Assessment of the Medicare Annual Wellness visit (AWV).  CMS notes that the United States Preventive Services Task Force is updating its 1996 recommendation regarding screening for hearing impairment in older adults. Consequently, until those recommendations are published, functional status screenings are found by CMS to be “…supportable by evidence only for the first AWV.”

 Any comments or questions should be addressed to reimbursement@asha.org

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

Chief Staff Officer, Speech-Language Pathology

American Speech-Language-Hearing Association

2200 Research Boulevard, #229

Rockville, MD  20850-3289

+1 301-296-5705 telephone

301-296-8577 fax

 

lmcneilly@asha.org

CMS Issues 2011 Medicare Physician Fee Schedule with Changes in Rehabilitation Payment Policy

On Tuesday, November 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2011 Medicare Physician Fee Schedule (MPFS). Each year CMS establishes a conversion factor (CF) that is used as a multiplier of the total relative value units (RVUs) for each procedure. The current CF is $36.8729.  Unless Congress acts, the CF is scheduled to be reduced to $28.4061, effective December 1, 2010, and $25.5217, effective January 1, 2011. This would represent about a 30 percent reduction from current payments and would affect all payments under the physician fee schedule. These reductions are due to the application of a statutory formula known as the Sustainable Growth Rate.  Please note that there is every indication that Congress will enact legislation to prevent these reductions from occurring.

Multiple Procedure Payment Reduction 

Medicare has a longstanding policy to reduce payment for the second and subsequent surgical and nuclear medicine procedures furnished to the same patient by the same practitioner on the same day. In the final rule, CMS expands the Multiple Procedure Payment Reduction (MPPR) to therapy services. Under MPPR, full payment will be made for the therapy service or unit with the highest practice expense value (MPFS reimbursement rates are based on professional work, practice expense, and malpractice components) and payment reductions will apply for any other therapy performed on the same day. For the additional procedures provided on the same day, the practice expense (i.e., support personnel time, supplies, equipment, and indirect costs) of each fee will be reduced by 25%, effective January 1, 2011. The professional work and malpractice expense components of the payment will not be affected.

 MPPR will primarily affect physical therapists and occupational therapists, that is, professions that commonly bill multiple procedures or a timed procedure billed more than once per visit. Eight SLP procedures (92506 Speech/hearing evaluation, 92507 Speech/hearing therapy, 92508 Speech/hearing therapy, 92526 Oral function therapy, 92597 Oral speech device eval, 92607 Ex for speech device rx, 1hr, 92609 Use of speech device service, 96125 Cognitive test by hc pro) are designated as applicable to MPPR. It will be a per-day policy that would apply across disciplines and across settings. For example, if an SLP and a physical therapist both provided treatment to the same patient on the same day, the MPPR will apply to all codes billed that day, regardless of discipline. The following three MPPR scenarios illustrate full payment being made for the procedure with the higher practice expense. If there is a single speech-language pathology service daily it will usually be paid without a reduction because of consistently low physical therapy and occupational therapy procedure practice expense values.

 Scenario 1

 A patient is seen on the same day for a speech/language evaluation (92506) and a physical therapy evaluation (97001).

  92506 97001 Total Payment w/o MPPR 2011 Total Payment w/MPPR
Work $21.95 $30.63 $52.58 No Reduction = $52.58
Practice Expense $57.68 $22.71 $80.39 $57.68 + (0.75 x $22.71) = $74.71
Malpractice $1.28 $1.28 $2.56 No Reduction = $2.56
Total $80.91 $54.62 $135.53 $52.58 + $74.71 + $2.56 = $129.85

 Scenario 2 

A patient is seen on the same day for speech/language treatment (92507) with a speech-language pathologist and 30 minutes of therapeutic exercises with a physical therapist (97110, each 15 minutes).

  92507 97110 Unit 1 97110 Unit 2 Total Payment w/o MPPR 2011 Total Payment w/MPPR
Work $33.18 $11.48 $11.48 $56.14 No Reduction = $56.14
Practice Expense $26.80 $10.72 $10.72 $48.24 $26.80 + (0.75 x $10.72) + (0.75 x $10.72) = $42.88
Malpractice $1.79 $0.26 $0.26 $2.31 No Reduction = $2.31
Total $61.77 $22.46 $22.46 $106.69 $56.14 + $42.88 + $2.31 = $101.33

 Scenario 3 

A patient is seen on the same day for speech/language treatment (92507) and swallowing treatment (92526).

  92526 92507 Total Payment w/o MPPR 2011 Total Payment w/MPPR
Work $34.20 $33.18 $67.38 No Reduction = $67.38
Practice Expense $34.71 $26.80 $61.51 $34.71 + (0.75 x 26.80) = $54.81
Malpractice $1.79 $1.79 $3.58 No Reduction = $3.58
Total $70.70 $61.77 $132.47 $67.38 + $54.81 + $3.58 = $125.77

 The 25% reduction in practice expense is an improvement from the proposed physician fee schedule released by CMS in August. The proposed physician fee schedule had set a 50% cut in the practice expense.  Moreover, the proposed rule included CPT code 92608 (speech-generating device evaluation, each additional 30 minutes) as also applicable to MPPR, but CMS removed this code in the final rule due to ASHA advocacy efforts.  ASHA also advocated against any cut in the practice expense and submitted comments on the proposed fee schedule.

 Therapy Caps and Alternatives

 CMS requested comments in the proposed physician fee schedule on three approaches for developing an alternative to the Medicare therapy caps.   The alternatives under consideration were the following: modify the current exceptions process by capturing additional patient information about severity and complexity; develop edits regarding medical necessity; or create per-session bundled payments.  ASHA has been working with CMS-contracted research projects to develop these proposals over the past two years and provided comments on these alternatives. In response to comments on the proposed rule, CMS concluded that none of the proposed alternatives are sufficiently developed to warrant immediate implementation. However, CMS stated that the first option (severity and complexity) may have the greatest potential for rapid implementation that could yield useful information in the short-term.  Few comments preferred option two (medical necessity edits) over the other two options. 

 The final rule also reiterated that the current exceptions process for the therapy cap will expire on December 31, 2010, absent Congressional action.  Most Capitol Hill observers anticipate that Congress will address both the sustainable growth rate (the underlying legislative formula for the conversion factor) and therapy caps during the 2010 lame duck session. 

 PQRI

 CMS will continue the current speech-language pathology Physician Quality Reporting Initiative (PQRI) measures through 2011. The eight speech-language pathology measures are Functional Communication Measures for spoken language comprehension; attention; memory; motor speech; reading; spoken language expression; writing; and swallowing.

 For 2010, the incentive payment for satisfactorily reporting on measures is 2% of all allowable Medicare charges for that reporting period. The final rule affirms the incentive payment structure set out in the Affordable Care Act (ACA):  an incentive payment of 1% for 2011 and .5% for 2012-2014. Starting in 2015, eligible professionals that do not satisfactorily report on quality measures will be subject to a payment adjustment.

 The speech-language pathology measures are reported via registry. Providers reporting on registry-based 2011 PQRI measures will still need to report on 80% of patients that fit into a measure.

 Any comments or questions should be addressed to reimbursement@asha.org

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

Chief Staff Officer, Speech-Language Pathology

American Speech-Language-Hearing Association

2200 Research Boulevard, #229

Rockville, MD  20850-3289

+1 301-296-5705 telephone

301-296-8577 fax

 

lmcneilly@asha.org

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