American Speech-Language-Hearing Association
March 12, 2013

Audiology and SLP Topics Covered on Medicare Provider Calls

The Centers for Medicare and Medicaid Services (CMS) has scheduled two provider calls of interest to audiologists and speech-language pathologists who submit claims for outpatient Medicare services.

  • Tuesday, March 19, 2013 from 1:30 to 3:00 p.m. (EST): 2013 PQRS and eRx Claims-based Reporting Made Simple

    This National Provider Call provides an overview of how to report for the Physician Quality Reporting System (PQRS) through claims, including how to start reporting, key points, scenarios, and tips for satisfactorily reporting. The presentation also includes information about the claims-reporting process, 2013 reporting periods and frequency, coding and measure specification, review of CMS-1500 form, and other helpful hints.

  • Wednesday, March 20, 2013 from 3:00 to 4:30 p.m. (EST): Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DMEPOS, and Part A Home Health Agency Claims

    Effective May 1, 2013, CMS will instruct contractors to turn on denial edits to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing. This edit is applied to Medicare Part B claims, including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider and Part A Home Health Agency (HHA) claims that require an attending physician provider.

Registration information for these free calls can be found at CMS Upcoming National Provider Calls and will close when space is full or at noon (EST) on the day of the call.

Background

The Patient Protection and Affordable Care Act (ACA) included requirements for participation in the PQRS, mandating that a 1.5% penalty would be applied to all Medicare claims in 2015 to all eligible professionals who do not participate in the program. CMS has determined that the penalty will be assessed to providers, including audiologists and speech-language pathologists, who submit non-institutional Medicare Part B claims in 2013 and do not report. The National Provider Call will address the details and instruct providers how to participate using the CMS-1500 claim form for PQRS reporting.

ACA also included provisions requiring referring providers-physicians, nurse practitioners, and physician's assistants-to be enrolled in Medicare. On May 1, CMS will activate a process that automatically denies payment for three categories-Part B services, durable medical equipment, and Part A home health claims-if the referring physician's National Provider Identifier is not recognized in the Medicare enrollment system, known as the Provider Enrollment, Chain, and Ownership System (PECOS). The National Provider Call will address those provider types eligible to order/refer as well as billing providers.

Additional Resources

For more information on PQRS, visit ASHA's website at The Patient Protection and Affordable Care Act: Physician Quality Reporting System (PQRS). For more information regarding the physician referral requirements, refer to the CMS MLN Matters publication Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856) [PDF].

For questions or additional information related to the ACA and its impact on audiologists and speech-language pathologists, please contact Lisa Satterfield, MS, CCC-A, ASHA's director of health care regulatory advocacy, at lsatterfield@asha.org.


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