The Middle Class Tax Relief and Job Creation Act (MCTRJCA) of 2012 (Pub. L. 112-96) mandated a claims-based data collection strategy for reporting patient condition and outcomes, "designed to assist in reforming the Medicare payment system for outpatient therapy services." Congress and the Centers for Medicare and Medicaid Services (CMS) have been exploring alternatives to therapy payment since the introduction of the therapy caps in 1997.
The implementation date was January 1, 2013. Claims that do not comply with the data reporting requirements will be returned unpaid. All providers of therapy services to Medicare Part B beneficiaries should ensure that they are in full compliance with reporting.
Documentation requirements in the medical record also began January 1, 2013. It is strongly recommended that beneficiaries that have the possibility of transitioning from Medicare Part A to Medicare Part B billing, or Medicare Part B as a secondary insurance, include the G-code and severity modifiers in the medical record with every evaluation and every 10th treatment day, consistent with Medicare guidelines. This will allow for correct reporting on the claim if Medicare Part B services are ever billed.
Anyone providing therapy, including speech-language evaluation and treatment services, for Medicare Part B beneficiaries must report outcomes on the claim form in this mandatory data collection program. This includes Part B services in
Reporting requirements do not apply to Medicare Part A, Medicare Advantage/HMO plans, Medicaid, or private health plans.
Seven of ASHA's National Outcomes Measurement System (NOMS) Functional Communication Measures were adopted by CMS for speech-language pathology related functional limitations. NOMS uses a similar 7-point scale which can correlate directly with the CMS 7-point severity scale. SLPs are not required to use NOMS for purposes of reporting on the claim form; however, NOMS will assist with
Visit the NOMS website for more information or to sign up.