Bottom Line: Stepping Into 2014: What Private Practitioners Need to Know Here’s the latest on new codes for billing your services for commercial payers, Medicaid and Medicare, as well as other regulations. Bottom Line
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Bottom Line  |   January 01, 2014
Bottom Line: Stepping Into 2014: What Private Practitioners Need to Know
Author Notes
  • Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. ·jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. ·jmccarty@asha.org×
  • Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plans and Medicaid advocacy. ·lalbanhavens@asha.org
    Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plans and Medicaid advocacy. ·lalbanhavens@asha.org×
Article Information
Practice Management / Bottom Line
Bottom Line   |   January 01, 2014
Bottom Line: Stepping Into 2014: What Private Practitioners Need to Know
The ASHA Leader, January 2014, Vol. 19, 30-32. doi:10.1044/leader.BML.19012014.30
The ASHA Leader, January 2014, Vol. 19, 30-32. doi:10.1044/leader.BML.19012014.30
Stepping Into 2014: What Private Practitioners Need to Know
Here’s the latest on new codes for billing your services for commercial payers, Medicaid and Medicare, as well as other regulations.
BY JANET MCCARTY AND LAURIE ALBAN HAVENS
Independent-practicing speech-language pathologists and audiologists who want to keep their private practices vibrant should take note of some changes to coding, privacy and other issues as we enter the new year.
New speech-language pathology evaluation codes Four new Current Procedural Terminology (CPT® American Medical Association) codes were created to replace CPT 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing). SLPs must bill speech, language, fluency and voice evaluations using the following codes:
  • 92521, Evaluation of speech fluency (e.g., stuttering, cluttering).

  • 92522, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria).

  • 92523, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language).

  • 92524, Behavioral and qualitative analysis of voice and resonance.

Find more details and FAQs at on.asha.org/new-2014-slpcodes. Medicare fees for the codes (the basis of many private payer and Medicaid reimbursement levels) is included in the 2014 Medicare Physician Fee
Schedule. See the article on p. 14 and ASHA’s analysis of the schedule (on.asha.org/medicarefeesched) for more information.
Keep two important points in mind:
  • Do not use the new evaluation codes for brief assessments that could be considered screenings. Time for identification of other disorders is already built into the value of each code and inappropriate use of multiple evaluations on the same day could result in restrictions through the National Correct Coding Initiative edits.

  • If you are evaluating a patient for language only, bill 92523 with the -52 modifier. This modifier indicates that the services provided are less than the full description of the service.

ICD-10-CM takes effect Oct. 1 Beginning Oct. 1, the new ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system replaces the current ICD-9-CM (9th Revision). ASHA has developed several resources to help audiologists and SLPs prepare: lists of the commonly used codes, an online tool to map ICD-9-CM codes to ICD-10-CM codes, and mapping spreadsheets (on.asha.org/icd-10-codes). Use the checklist—which addresses topics such as contacting billing clearinghouses, updating payer contracts with new codes, developing a timeline for staff training and budgeting for changes—to make an organized transition to ICD-10-CM.
New proposed ICD code for social pragmatic communication disorder ASHA supports the American Psychiatric Association’s proposed ICD-10-CM code for social pragmatic communication disorder, an outcome of changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The DSM-5 groups all autism subcategories into a single category— autism spectrum disorder—and eliminates the diagnosis of Asperger syndrome. Individuals who no longer meet the criteria for autism spectrum disorder (or Asperger syndrome) under DSM-5 may be diagnosed with a social pragmatic communication disorder, and adding a specific billing code to capture that diagnosis may be helpful for reimbursement. ICD codes are mandatory (per the Health Insurance Portability and Accountability Act) for all third-party electronic billing and reporting, but DSM-5 codes are not. However, health plans, schools and other programs can adopt the DSM-5 criteria for defining disorders.
Patients and providers should not assume that a condition or treatment covered in a previous year is automatically covered in the next year—even in the absence of major health care reform.
ASHA is preparing a new brochure for consumers on social pragmatic communication disorders that will help ASHA members inform patients and families about this disorder.
HIPAA
Health Insurance Portability and Accountability Act privacy rules went into effect Sept. 23, 2 0 13 (on.asha.org/leader-hipaa). Providers should conduct a risk analysis by answering a series of sample questions or completing a template (bit.ly/nist-hipaa-tool) that will help them prioritize the development and implementation of a HIPAA compliance plan. Questions cover aspects of practice including administrative, physical and technical safeguards, and breach notification rules that address the broad categories of privacy and security.
Keep the completed risk assessment and associated documents in your HIPAA security files to demonstrate that you have evaluated the risk associated with your practice. HIPAA security requires covered entities (audiologists and SLPs are included in this group) to protect against any reasonably anticipated threats or hazards to the security or integrity of protected health information that is electronically submitted, and to implement security measures that reduce risks and vulnerabilities to a reasonable and appropriate level. You can use the information you gather to develop privacy policies for your practice and the privacy notice you give to clients.
Many factors—size of the practice, nature of data transmission, insurers billed, and number of employees and contractors/sub-contractors— affect the security measures you need. However, all practices must ensure the privacy of gathered and shared client information (on.asha. org/hipaa-rules). Notices need to be reviewed and updated regularly to make sure they include new areas such as restrictions on marketing, requests by the client for electronic versions of records and disclosing genetic information.
Physician Quality Reporting System PQRS is a mandated quality program of the Centers for Medicare and Medicaid Services designed to drive best practices and to offer quality information to Medicare beneficiaries through the Physician Compare website. Under PQRS rules, audiologists and SLPs in private and group practices who do not participate fully in 2014 will be
penalized by 2 percent on all claims for Medicare Part B services in 2016.
Affordable Care Act Under the Patient Protection and Affordable Care Act, health care insurance marketplaces (exchanges) may offer health insurance to uninsured or underinsured people (on.asha.org/aca-info) and states may expand their Medicaid programs to include coverage for those whose income exceeds Medicaid eligibility amounts. The coverage requirements for both ACA components have had an effect on the private insurance market, and some private insurance plans have been cancelled, either because they were not compliant with ACA or because insurers didn’t want to include the minimum essential health benefits mandated by the ACA.
For example, the ACA requires exchanges to offer habilitation and rehabilitation services and devices, including speech-language pathology and audiology services. In addition, the cost of premiums for new plans that meet these standards may be more expensive than those for previous plans. As a consequence, some clients no longer have coverage for these services.
Patients and providers, therefore, should not assume that a condition or treatment covered in a previous year is automatically covered in the next year—even in the absence of major health care reform. Coverage (or non-coverage) may change from year to year and from employer to employer, as do reimbursement rates and frequency and duration of treatment, in all models of health care payment.
Move to alternative payment models Medicaid and private insurers are beginning to adopt alternative payment models that are value-based, rather than volume-based. In the episodic care model, for example,
provider payment is based on predicted episodes of care rather than on billing codes or visits. An episode of care extends from evaluation to discharge; the provider keeps any patient copayments or coinsurance in addition to the case rate. The level of care is determined by the payer based on the provider’s evaluation, and ranges from a single visit to intensive treatment. Under this model, providers who take a conservative approach and help the patient reach his or her goals efficiently make more money. Industry observers anticipate an increasing shift to this health care system.
Information
ASHA’s new guide, “2014 Coding and Billing for Audiology and Speech-Language Pathology” (available for purchase at www.asha.org/shop, Item #0113382), compiles information about 2014 payment regulations and policies from the ASHA website in one volume. The guide includes information on CPT codes, including the four new evaluation codes; transitioning from ICD-9 to ICD-10 codes; average charges per CPT code nationwide; and Medicare G-code outcomes reporting requirements. It also has sample customizable superbills, a chart of commonly used diagnostic and procedure codes, and documentation guidance to justify treatment.
For questions or feedback on any of these issues, contact reimbursement@asha.org. Image Not Available
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January 2014
Volume 19, Issue 1