American Speech-Language-Hearing Association
July 13, 2011

2012 Revisions to Medicare Fee Schedule Proposed

The Centers for Medicare and Medicaid Services (CMS) posted the proposed 2012 Medicare Physician Fee Schedule (MPFS) on July 1, 2011; it will be published in the Federal Register on July 19. The MPFS includes fees for audiology and speech-language pathology services.

CMS continues to expand the Multiple Procedure Payment Reduction (MPPR) Policy to reflect efficiencies that occur when services are furnished by a professional to a single beneficiary on the same day. CMS is inviting comment on applying the MPPR to all diagnostic tests, including audiology testing.

CMS proposes to continue the current audiology and speech-language pathology Physician Quality Reporting System (PQRS) measures through 2012 and adds one new audiology measure. The proposed audiology measure for 2012 is referral for otology evaluation for patients with acute or chronic dizziness. The proposed rule sets an incentive payment of 0.5% for 2012–2014. Starting in 2015, eligible professionals who do not satisfactorily report on quality measures will be subject to a penalty. Speech-language pathologists and audiologists interested in participating in PQRS will find further information at on ASHA's website.  

The changes in the practice expense formula primarily affect the calculation of indirect practice costs (e.g., office overhead, billing, rent, utilities). For 2012, practice expense values will be based on 25% of prior data and 75% of new survey data. This new system has negative effects on audiology and speech-language pathology, mostly because the costs of operating an audiology or speech-language pathology practice are substantially less than those of physicians. ASHA is analyzing the effect of the two PE calculation approaches and will send comments to CMS.

CMS again proposes to make a negative adjustment to the PE for group treatment for speech, language, voice, communication, and/or auditory processing disorders.

The most critical issue for ASHA members is the effect of the proposed rule on payments to audiologists and SLPs in 2012. Congress has not yet resolved the issue of the formula that determines the annual MPFS update. Under current law and formula, across-the-board reductions of about 29% are indicated for all MPFS services. However, most observers—including ASHA leadership—are confident that Congress will again act to prevent the implementation of these massive reductions in payment for all services.

Please see the upcoming issue of The ASHA Leader for details. For questions, please contact reimbursement@asha.org.


Share This Page

Print This Page