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Current Legislative/Regulatory Activity
2021 Medicare Payment Cuts
As expected, the Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed rule [PDF] for the Medicare Physician Fee Schedule (MPFS) for outpatient services. Significant policies addressed in this rule include—but are not limited to—payment cuts for audiology, speech-language pathology, and other services; new codes for remote therapeutic monitoring (RTM); audio-only virtual check-in services; telehealth services; quality reporting; and Alternative Payment Models.
Audiology and speech-language pathology services under Medicare Part B (outpatient) have payment rates established by the MPFS. Medicare also pays for most speech-language pathology services provided in hospital outpatient settings based on the MPFS. However, audiology outpatient hospital services are paid under the hospital outpatient prospective payment system (OPPS).
CMS did not propose specific changes to mitigate the payment cuts set to return in 2022 for audiologists, speech-language pathologists (SLPs), and over 30 other Medicare provider groups. These cuts would have gone into effect in 2021 due to changes in payment for outpatient office-based evaluation and management (E/M) services and adjustments to the annual conversion factor, but advocacy by ASHA and other stakeholders resulted in legislation that significantly mitigated cuts by 3.75%. However, the 3.75% adjustment is set to expire at the end of 2021, meaning that the cuts will resume in 2022 without additional action from Congress or CMS.
It is expected that ASHA will develop and submit comprehensive comments on the proposed rule by early September and may invite OSLHA constituents to weigh in or extend support for their comments. Keep your eye out for opportunities to support this effort!
New legislation passed in December 2020 will have an impact on the Medicare Plan B payment reductions expected to take effect on January 1st. There was an increase of 3.75% applied through 2021, delay of implementation of the GPCX1 add on code, and a waiver of the 2% sequestration reduction for the first 3 months of 2021. The result is that anticipated reductions have been reduced but calculating the exact impact is still underway. ASHA is working to compile information to better explain the additional changes and how they will impact SLPs and Auds. This information is expected to be published in an upcoming ASHA Headline. However, unless Congress takes additional action before the end of 2021 the previously expected reductions will go back into place on January 1, 2022
A new bill to address proposed 2021 Medicare Part B cuts to reimbursement of audiology and speech-language pathology services was introduced in the U.S. House of Representatives. H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, would help address these cuts by providing relief payments to audiologists and SLPs in an amount that will ensure parity with current payment for impacted services for the next two years until a longer-term solution is developed.
Retroactive Corrections Being Accepted for Unintentional CCI Edit that Prevented Same-Day Billing of Videofluoroscopic Swallowing Study by SLPs and Radiologists
In a recent communication, CMS noted that corrections have been made to an unintentional edit that prevented same-day billing of 92611 and 74230. We are pleased to report that with the reversal of the CCI edit, Speech-Language Pathologists (SLPs) and Radiologists will once again be appropriately reimbursed for each distinctly different portion of their professional collaboration during the videofluoroscopic swallowing study (VFSS). Billing adjustments will be retroactive to January 1, 2020, and the wording will be implemented as soon as technically possible in a future edit update!!
CMS further clarified that claims for same-day billing of 92611 and 74230 must include a modifier to note that the services are separate and distinct. This means that claims for VFSS should include 92611 first on the claim, as the “column 1” code, followed by 74230 with the modifier -59 (or subcategory modifiers) appended. Additional information on the use of CCI-associated modifiers is available on ASHA’s website.
Effective January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) implemented a new National Correct Coding Initiative (CCI) edit that prevents same-day billing of Current Procedural Terminology (CPT ® American Medical Association) codes 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) and 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording).
Speech-language pathologists (SLPs) typically collaborate with radiologists to perform the videofluorscopic swallowing study (VFSS), also called the modified barium swallowing (MBS) study. CPT codes 74230 and 92611 describe the work required to identify the medical diagnosis by the radiologist (74230) and to evaluate swallowing function by the SLP (92611). With the new CCI edit in place, SLPs and radiologists will not be appropriately reimbursed for each distinctly different portion of their professional collaboration during the VFSS.
ASHA is engaging with CMS and the contractor that manages the NCCI program to resolve this issue. In the meantime, ASHA recommends providers continue to submit same-day claims for 92611 and 74230. Because the new CCI edit lists 92611 as the “column 1” code, it should be placed first on the claim, followed by 74230. This means that 92611 should be processed for payment, but 74230 will be denied. If CMS reverses the CCI edit, all claims submitted since January 1, 2020, can be reprocessed for payment of 74230.
The NCCI (or more commonly, CCI) is an automated edit system to control specific procedure code pairs that can or cannot be reported on the same day. CMS developed the system for use in all Medicare Part B (outpatient) and Medicaid claims. See CCI Edits for Speech-Language Pathology Services for additional information on same-day billing restrictions.
ASHA NOMS Release Date Delayed
What does this mean for you and your clinicians?
You should continue to participate in the current version of NOMS as usual. All new NOMS users will still need to be registered for the adult and/or pre-kindergarten NOMS user training(s) in order to submit data. However, users who complete the training after December 31st will not receive ASHA CEUs but will still earn professional development hours. Please let any clinicians who have not completed the training know about this deadline.
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