August 3, 2010 Feature

Medicare Fees Get Temporary Fix

Legislation signed into law at the end of June sets reimbursement for speech-language pathologists and audiologists who provide services to Medicare beneficiaries through Nov. 30, 2010, at a rate 2.2% higher than 2009 levels.

The new law is retroactive to June 1, the expiration date of previous rate-setting legislation.

This law is the third in a series of legislative actions that have prevented the 2010 Medicare Physician Fee Schedule (MPFS)—which cuts Medicare Part B payments by 21.2% from the 2009 MPFS—from taking effect. In previous actions, Congress postponed implementation of the 2010 fee schedule, originally scheduled for Jan. 1, 2010, first to April 1 and then to June 1.

When Congress failed to take action by June 1 to postpone implementation of the new rates again, the 2010 fee schedule took effect. SLPs and audiologists who submitted claims for services provided June 1–June 25 (the date the law was enacted) should resubmit those claims for reimbursement at the rates established in the new legislation (2009 MPFS plus 2.2%), titled the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.

New 2011 Rates 

The Centers for Medicare and Medicaid Services (CMS) recently posted its proposed rule for the 2011 MPFS. ASHA is analyzing the 1,200-page rule and will provide comments by the Aug. 24 deadline.

The rule proposes a fee reduction of 6.1%—in addition to the 21.3% reduction that has been delayed this year—based on the sustainable growth rate (SGR) formula used since 1997. However, Congress is expected to act once again to prevent these reductions from taking place.

New 2011 Regulations 

The rule also includes several new proposals:

A multiple procedure payment reduction policy (MPPR) for therapy services. Medicare has a long-standing policy regarding second and subsequent surgical and nuclear medicine procedures furnished to the same patient by the same practitioner on the same day. CMS proposes to expand MPPR to therapy services; it will fully reimburse for the therapy service or unit with the highest practice expense value, and for additional procedures on the same day, reduce practice expense (i.e., supplies, equipment, and indirect costs) but not professional work and malpractice expense components of the therapy service payment.

MPPR will primarily affect professions that often bill multiple procedures or bill a timed procedure more than once per visit. Nine speech-language pathology procedure codes are applicable to MPPR. For example, if an SLP provided a speech-language visit on the same day as a dysphagia visit to the same patient, payment for the dysphagia visit would be reduced by 50% of its practice expense (yielding a 24% reduction).

Therapy cap alternatives. CMS has requested comments on three proposals for developing an alternative to the current cap on outpatient therapy services. ASHA has been working with CMS-contracted research projects to develop these proposals over the past two years. Alternatives would modify the current exceptions process based on severity and complexity; develop edits regarding medical necessity; or create per-session bundled payments. Absent congressional action, the exceptions process expires Dec. 31, 2010.

Physician Quality Reporting Initiative (PQRI). CMS proposes to continue the current audiology and speech-language pathology PQRI measures through 2011. The 2010 incentive payment for satisfactorily reporting on measures is 2% of all allowable Medicare charges for that reporting period. The proposed rule sets an incentive payment of 1% for 2011 and 0.5% for 2012–2014. Starting in 2015, eligible professionals who do not satisfactorily report on quality measures will be subject to a penalty. This penalty will be a reduction in payments of 1.5% in 2015, and 2% in 2016 and each subsequent year. Providers participating in PQRI need to report on 80% of patients who fit into a measure; in the proposed rule, providers would need to report on only 50% of patients who fit into a measure.

Telehealth. CMS makes clear that telehealth services are covered by Medicare only when specific professions are designated by law. ASHA will work with the Center for Medicare and Medicaid Innovation (a department within CMS created under health care reform) to explore ways in which telehealth services delivered by SLPs may eventually be covered by Medicare.

The Aug. 31 issue of The ASHA Leader will include more information about the 2011 rule and ASHA's comments to CMS. 

Ingrida Lusis, director of federal and political affairs, at

cite as: Lusis, I. (2010, August 03). Medicare Fees Get Temporary Fix. The ASHA Leader.


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