November 4, 2008 Feature

Answers to Questions About Medicare Changes

Since the July passage of the federal Medicare Improvements for Patients and Providers Act (MIPPA), ASHA staff has sought to equip members interested in serving Medicare patients. As first described in the Sept. 2 issue of The ASHA Leader, MIPPA takes effect July 1, 2009. On that date, private-practice speech-language pathologists who have enrolled as Medicare providers will be able to bill Medicare directly for services delivered to beneficiaries under Medicare Part B.

Selected questions from a Sept. 23 ASHA teleseminar on MIPPA implementation are excerpted here. The full text of the Q&A is available at The Leader Online, along with other articles on the countdown to Medicare.

Q: Is the National Provider Identifier (NPI) portable?

Yes. Once you have received an NPI, it is your number to be used for all health plan payers.

Q: I have an NPI for my private practice. Will I be able to use that for Medicare?

Yes. Your NPI can be used for both private insurance and Medicare. Remember that applying for an NPI does not automatically enroll you in the Medicare program; that is a separate process. Information on Medicare enrollment can be found on ASHA's Web site.

Q: I am a Medicare provider under my audiology number—do I need to enroll again?

Yes. You need to enroll separately in the program as an SLP. Your NPI application/record should include the audiology and speech-language pathology taxonomy codes.

Q: Can I bill independently and also as part of a corporation where my benefits are reassigned?

Yes. The reassignment of payment only applies when the claim form identifies that corporation as the "billing provider."

Q: How do I verify Medicare eligibility on patients?

To verify Medicare eligibility, contact your Medicare administrative contractor. For Medicare
contractor contact information, visit the HHS Web site [PDF].

Q: Will a physician still be able to bill "incident to" for speech-language pathology services?

Yes. Whether or not an SLP enrolls in Medicare, his/her services can be billed as an employee or contractor of a physician practice.

Q: Do we know yet if SLPs will be able to see patients in home settings or must patients come to an office?

SLPs will have the option of seeing patients in an office or the patient's home. ASHA has requested that CMS include in its draft regulations a third patient care setting—"patient's natural environment"—when there is a need to treat patients in the locations where they participate in daily activities.

Q: How soon after I submit my claims can I expect payment from Medicare?

The Medicare contractor is expected to process "clean" claims within 30 days. A claim that is incomplete or contains an error does not satisfy the "clean" definition. Please note that the payment process is shortened if claims are submitted electronically.

Q: Does the change in speech-language pathology private-practice status change the therapy caps?

No, the legislation does not change the therapy caps, and SLPs continue to share a cap with physical therapy. The legislation did, however, call for the continuation of the therapy cap exceptions process that allows beneficiaries to receive additional therapy services above the cap if they are medically necessary.

Q: What is the Physician Quality Reporting Initiative (PQRI)?

PQRI allows physicians or other professionals to receive a bonus payment when they report recognized quality measures to Medicare. SLPs are one category of providers eligible for this bonus payment. ASHA is working with the Centers for Medicare and Medicaid Services to recognize functional communication measures from ASHA's National Outcomes Measurement System for reporting purposes.

Mark Kander, director of health care regulatory analysis, can be reached at

Ingrida Lusis, director of political and federal advocacy, can be reached at

cite as: Kander, M.  & Lusis, I. (2008, November 04). Answers to Questions About Medicare Changes. The ASHA Leader.


Advertise With UsAdvertisement