Medicare and Reimbursement Guidance from our StAMP and STAR Representative
STATE ADVOCATES FOR MEDICARE POLICY (StAMP)
STATE ADVOCATES FOR REIMBURSEMENT (STARs)
I am addressing some frequently asked questions:
“For Part B settings, is it acceptable to bill an evaluation code like 92526, and on that same day/for that same session bill a treatment code like 92507?
From my perspective, the simplest answer is that we should develop a plan of care that meets the patient’s clinical needs. This is regardless of the duration of the services needed or the estimated cost of care. I suggest the following plan:
- Development of the plan of care to meet the medical necessity of the patient.
- Document the clinical rationale (it’s helpful to reference evidence based practice).
- Assure medical record entries give evidence to the appropriateness and timeliness of the services provided.
With or without a therapy cap, it is possible you could find yourself having to appeal for payment of the services. If the plan is patient-centered and the clinical rationale is sound, you will be doing all you can to assure the patient gets appropriate care.
The CPT Code 97532 for cognitive treatment code has been discontinued as of 12/31/2017. ASHA report that this code has been discontinued due to over use by occupational therapy.
The replacement CPT Code is 97127. This is an untimed code.
CMS (Center for Medicare and Medicaid Services) reported that Medicare will NOT cover the 97127 CPT Code.
Medicare will cover the following for cognitive treatment G0515. This CPT Code is a timed code reported in 15-minute units.
The confusion is which code private payers will reimburse. Both CPT Codes can be billed by any payer.
This will mean each company will need to be contacted to discover which code can be billed to determine your reimbursement; which creates confusion and extra work for you in your treatment and business.
Montana Medicaid covers the G0515 CPT Code rather than the 97127.
Stay tuned to the latest updates on the therapy cap. As of the time that I am writing this report, the therapy cap is in the 20th year. ASHA is addressing abolishing the cap on therapies. To date the ability to appeal for additional sessions is nixed; however, my ASHA resources expect this to be appealed allowing for appeals for additional treatment sessions.
Montana Medicaid will NOT cover the 97127 for cognitive treatment.
I reached out to clarify the cognitive coverage for Montana Medicaid. I was contacted by Rena Stayaert, Montana Medicaid Program Officer, School Based Services, Optometric therapies.
She reported that the code that will be reimbursed for cognitive treatment by Medicaid is G0515 and the charge will be reimbursed in 15-minute units with a maximum charge per day is 8 units for a two-hour session.
For clarification Rena can be contacted by the following:
No new issues.
StAMP and STARs both are influenced by the following:
Multiple Procedure Payment Reduction (MPPR)
MPPR is a per-day policy that applies across disciplines and across settings. For example, if an SLP and a physical therapist both provide treatment to the same patient on the same day, the MPPR applies to all codes billed that day, regardless of discipline. Under MPPR, full payment is made for the therapy service or unit with the highest practice expense value (MPFS reimbursement rates are based on professional work, practice expense, and malpractice components) and payment reductions will apply for any other therapy performed on the same day. For the additional procedures provided on the same day, the practice expense (i.e., support personnel time, supplies, equipment, and indirect costs) of each fee will be reduced by 50% (effective April 1, 2013) for Part B services in all settings. The professional work and malpractice expense components of the payment will not be affected. ASHA has developed three MPPR scenarios to illustrate how reductions are calculated.
MPPR primarily affects physical therapists and occupational therapists because they are professions that commonly bill multiple procedures or a timed procedure billed more than once per visit. Eight speech-language pathology procedures are designated as applicable to MPPR.
Speech-Language Pathology Codes Subject to MPPR
- 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- 92508 – Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals
- 92521 – Evaluation of speech fluency (eg, stuttering, cluttering)
- 92522 – Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
- 92523 – Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
- 92524 – Behavioral and qualitative analysis of voice and resonance
- 92526 – Treatment of swallowing dysfunction and/or oral function for feeding
- 92597 – Evaluation for used and/or fitting of voice prosthetic device to supplement oral speech
- 92607 – Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour
- 92609 – Therapeutic services for the use of speech-generating device, including programming and modification
- 96125 – Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
Please contact me if you have any issues/challenges with coding, documentation and reimbursement.
Congratulations MT Licensure Board!
October 12, 2017
Lucy Richards and the entire Montana Board of Speech-Language Pathologists and Audiologists were instrumental prior to and during the process of passage of HB 347 (Limited Speech-Language Pathologist License). MSHA wants to thank Lucy and the Board for their commitment, professionalism and many hours of dedication. In addition MSHA members consistently attend Board Meetings and are welcomed and provide information as well as provide feedback and suggestions. The Board has been open to communication and working with the MSHA members.
Lucy Richards and the Board have provided timely and helpful updates on the website, there is now a quarterly newsletter. FAQs appear on the website as do approved CE coursework. Questions left on the phone or via email are answered in a timely manner.
Lucy has paperwork prepared in advance for the board to perform their duties in a cost effective and timely manner. Budgets were available and many needed revisions to rules were completed this year in part to the administrator’s organization prior to each meeting where discussion was orderly and easily understood by audience members who frequently included our members and graduate students.
The Board worked to determine a reduction in cost for initial renewal licenses. Lucy
Richards will be attending the first day of the MSHA Fall conference in Missoula and be available to answer questions at an exhibitor table.
I enthusiastically support this MSHA Organization Award for Lucy Richards and the entire Montana Board of Speech-Language Pathologists and Audiologists. We look forward to working with them in the future and during the next Montana Legislative Session in 2019.
Lezlie Pearce-Hopper, M.S., CCC-SLP
Montana Speech Language and Hearing Association (MSHA)
Montana Telepractice Turns 5: Webinar March 13, 2018
MSHA is committed to bringing educational opportunities! Keep your calendar available for a webinar on Tuesday March 13, 2018 to participate in Montana Telepractice Turns 5 by Rachel Stansberry and Diane Simpson. Attend and find out about what’s changed and where we’re going in Telepractice. Resources and recommendations will be provided! More details to come!
Temporary Conference Planning Position for a Student in CSD Program
Temporary Conference Planning Position
Open to a Graduate or Undergraduate Student in CSD Program
You will be hired by and work for the Montana Speech/Language and Hearing Association. All work is conducted from your computer and/or cell phone. This position will commence following the 2017 October Annual conference and end with the 2018 Annual Conference 10/18/18-10/20/18. You will coordinate with the incoming President of the Montana Speech/Language and Hearing Assoc. (MSHA).
- Current MSHA student member or ability to become one
- Ability to follow detailed verbal and written directions from supervisor
- Keyboard/computer experience including working knowledge of Excel, Word, and Power point
- Book conference facilities for Missoula 2019, Billings 2020, Missoula 2021
- Coordinate and make arrangements with conference speakers
- Send out fee information and book the exhibitors
- Obtain door prizes and auction items
- Invite past presidents to breakfast Saturday morning of conference
- Invite guests to president’s reception following Wed. Board Meeting
- Organize poster session
- Keep detailed log for reimbursement of hours
- Update conference policies and procedures handbook with President
- Determine AV needs and posting presenter handouts online
- Determine with supervisor which duties may be given to hired first year
Hours: Average 1-2 hours per week with increased hours possible 2-3
weeks prior to the October conference (5-6 hours per week). Hours are
flexible with your schedule. Attendance each day of the conference is
Duration: 1/15/18 through 10/20/18
Pay: Beginning wage is $12.00/hr. Pay is not to exceed $1500.00
You will be periodically evaluated to determine your eligibility to advance to $15.00/ hour with exceptional performance.
Print hard copy application here> APPLICATION FOR EMPLOYMENT, fill out, and return to MSHA.
Resumes will NOT be accepted without a completely filled out application.
Accepting applications until the position is filled!
Survey Extended! Please complete this short survey by January 31st!
We want all Montana SLPs and AUDs to complete a survey on your opinions regarding aides and assistants. Please click the link below and complete this short survey! Please complete this survey by this Friday January 19, 2018! This will take less than 5 minutes to complete!
FEES Course Coming this June!
Check out this continuing education opportunity!
Carolina Speech Pathology has a comprehensive Two Day FEES® Training Course “Fiberoptic Endoscopic Evaluation of Swallowing: A Procedure for Evaluating Oropharyngeal Dysphagia” coming to Great Falls, Montana June 9-10 2018. Get registered now!
This course will be taught by Kristin Sears-Kopp, M.A., CCC-SLP and Selena Reece, M.S., CCC-SLP, BCS-S. These energetic instructors have competed thousands of FEES across a variety of settings and have been deemed competent in supervision and training in FEES by board certified Otolaryngologists.
Thanks to Bridget Loomis, SLP for organizing this opportunity!
I am a SLP who works at Kalispell Regional Medical Center and a member of MSHA. I recently reached out to the developer and trainer for the ARK-J training program which treats trismus associated with head a neck cancer and offered to host a training at KRMC. I wanted to extend this training opportunity to all Montana SLPs as the training can accommodate 20-25 people and with a larger group we can reduce costs.
Please email Megan Eandi at email@example.com if you are interested in this opportunity.
Diane Simpson shares about SOS (Strategies Offer Solutions)
I am a speech language pathologist serving preschool through high school age students. I primarily serve as an in- person therapist; but, in the last three years, I have also served home school and public- school students via telepractice. I love my work because no two students are alike and I get to learn and grow with them. As both an in -person therapist and a telepractitioner, I have had the opportunity to evaluate how I serve students. I try to create a great learning environment in my speech therapy room. My students come in and we get right to work until another student appears and says that it’s time for “John” or “Sally” to come back to class for a) gingerbread house building, b) practice for the upcoming music program, c) fire drill, d) balloon lady, etc. It can be challenging to share student’s time with other professionals. We all teach important skills and we all need time with the same students. The question for me, how can I help students achieve their goals and incorporate the skills they are learning in other settings? I was determined to find a solution, not unique to my little corner of the world. I did some research and found a continuing education opportunity that sounded, promising! For the last several months, I have been using a strategy based program created by two speech pathologists plagued by the same issues as I. Yea, I’m not alone! Ruthann Jarvis and Elizabeth Peterson created Strategies Offer Solutions to teach strategies that can be easily incorporated into the classroom, home, and other settings to help students achieve their speech and language goals.
I began using this program last fall with my language students. This fall I included more students. I have enjoyed Strategies Offer Solutions because it often works well with the materials and programs that I already use. Ruthann Jarvis and Elizabeth Peterson also share ideas for teaching their strategies. The strategies taught are short and easy for students to remember. Parents can learn the strategies and use them at home to help build their child’s speech and language skills. I have a couple of parents who were thrilled to have something that they could use at home. This strategy program works well in both an in person and telepractice setting. I taught my telepractice students these strategies and they learned them as well as the students I see in-person.
If this sounds like the solution you have been searching for, please check out Strategies Offer Solutions on this web-site: https://www.northernspeech.com/best-seller/strategy-based-interventions-for-the-school-age-child/
Check out some new posts and ideas!
One Class At A Time: Rossiter Elementary School
Bridget Loomis is asking MSHA members to take this survey to find the best, possible weekend to hold a FEES course. The survey is designed so that members can choose multiple dates that they are available. Please go to this link now: https://www.surveymonkey.com/r/3WHWMV8
MSHA Member Webinars
On September 19, MSHA wrapped up it’s last webinar for 2017 with Tracy Sippl presenting on Teletherapy. Tracy provided an overview of how to get started in Tele-speech with technology needs, privacy compliance, and practice. She advocated for the use of Tele-speech in rural areas as well as with different populations. If you missed this class, Tell me about Teletherapy From A-Z, it is available with the link below.
Course description: Numerous websites offer Teletherapy opportunities, but what do you need to know before becoming a Speech/Language Teletherapist? Various facets of teletherapy: equipment, licensure, HIPPA-compliance, and materials are explained in detail. After completing this course, attendees will have the necessary information to genuinely consider becoming a Teletherapist.
Tracy has a lot of good information on her website and in her Blog. She is also available for individual practice sessions for teletherapists. https://www.s-lteletherapyconsulting.com/