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Following ASHA's request for revision of the values for our procedures through the Five-Year Review process, the American Medical Association (AMA) Relative Value Update Committee (RUC) requested that the Centers for Medicare and Medicaid Services (CMS) rule on whether the services provided by audiologists and speech-language pathologists were eligible for valuation as professional services. To date, there has been no response to the RUC from CMS. This scenario is a prelude to the comments submitted to CMS by ASHA regarding the proposed 2006 Medicare Physician Fee Schedule (MPFS). ASHA has maintained that the services provided by audiologists and speech-language pathologists are professional and not technical in nature.
The 2006 proposed MPFS was published in the Federal Register on August 8, 2005. The major area of concern for ASHA's comments were the dramatic cuts phased in over four years, beginning in 2006, for most audiology and many speech-language pathology procedures because of the proposed elimination of the non-physician work pool (NPWP) in the resource-based relative value scale (RBRVS). The NPWP serves as a safety net for all procedures composed of practice expense but have no value in the professional component (also known as physician work). Practice expense reflects the time of the individual assisting the physician and the expense of supplies and equipment for the procedure. The vagaries of revising the fee structure annually have had an impact on all of the procedures except those in the NPWP. That will all change with the 2006 proposed formula.
ASHA argued that the proposed reduction of 21% over four years for audiology services would have a devastating impact on the provision of services. We recommended that "…CMS maintain the current practice expense values for these services through 2006…." The moratorium would provide the time necessary to revise the formula and take into account the professional nature of the services. ASHA presented a rationale for providing a professional work component, including: (1) the type of services that are performed by the audiologist, (2) policies by CMS that allow audiologists to bill for the professional component, (3) the advanced learning and training of an audiologist, and (4) direct Medicare billing. Similar arguments were made for speech-language pathologists to be eligible for the professional component, including recognizing services provided as being comparable to physical therapists and occupational therapists that have professional work assigned to their procedures.
A legal brief was included in the comments that described the statutory authority for professional work for both audiologists and speech-language pathologists. The brief concluded that the Secretary of Health and Human Services has the authority to "establish ancillary policies as may be necessary to implement the RBRVS." Therefore, "the Secretary is authorized by the express language of the organic legislation to develop non-zero values for the work components of those procedures performed by speech-language pathologists and audiologists." For more information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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