First the Bad News-Then the Good: 2006 Rates Cut, but Some Policies Improved Reductions in Medicare reimbursement outlined in the 2006 Medicare Physician Fee Schedule (MPFS)-which Congress could remedy in its budget reconciliation bill-will reach 4.4% next year and, left unchanged, will mean a 26% overall reimbursement cut over the next six years. The Centers for Medicare and Medicaid Services (CMS) published the ... Policy Analysis
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Policy Analysis  |   December 01, 2005
First the Bad News-Then the Good: 2006 Rates Cut, but Some Policies Improved
Author Notes
  • Ingrida Lusis, director of federal and political affairs, can be reached at ilusis@asha.org.
    Ingrida Lusis, director of federal and political affairs, can be reached at ilusis@asha.org.×
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   December 01, 2005
First the Bad News-Then the Good: 2006 Rates Cut, but Some Policies Improved
The ASHA Leader, December 2005, Vol. 10, 1-26. doi:10.1044/leader.PA.10172005.1
The ASHA Leader, December 2005, Vol. 10, 1-26. doi:10.1044/leader.PA.10172005.1
Reductions in Medicare reimbursement outlined in the 2006 Medicare Physician Fee Schedule (MPFS)-which Congress could remedy in its budget reconciliation bill-will reach 4.4% next year and, left unchanged, will mean a 26% overall reimbursement cut over the next six years. The Centers for Medicare and Medicaid Services (CMS) published the 2006 MPFS in the Nov. 21 issue of the Federal Register.
Due to inaction by Congress, the 2005 MPFS conversion factor-the multiplier that converts relative value units (RVUs) to payment amounts-was reduced by 4.4% to $36.1770 for 2006. The projected cuts for the next six years are the result of the “sustainable growth rate” (SGR), the component of the fee schedule that considers the growth in outpatient services. The SGR automatically reduces yearly fee schedule updates whenever Medicare spending exceeds an arbitrary budget target.
Action is underway in Congress, with a budget reconciliation bill being considered including language that would provide for a 1% overall increase in Medicare that would prevent the reduction in rates. Since the bill’s fate remains uncertain, speech-language pathologists and audiologists should prepare for the 4.4% decrease.
CMS did announce it will continue the use of the non-physician work pool (NPWP) for at least a year. The agency had proposed eliminating the NPWP in 2006, which would have reduced audiology services by 21% over a four-year period-in addition to the fee schedule cuts. The continued use of the NPWP will maintain, or closely approximate, the current total relative value units (RVUs) of services, which will help prevent further erosion of audiology reimbursement rates.
ASHA lobbied hard against CMS’s proposed elimination of the NPWP and will continue to work with both CMS and Congress on alternatives to the zero work pool.
Code Changes
Four new auditory rehabilitation Current Procedural Terminology (CPT)* codes have been established for 2006. Two of the codes are for evaluation and two are for treatment. Because audiology is recognized as a diagnostic-only service by Medicare, CMS assigned RVUs only to the evaluation codes. Speech-language pathologists and audiologists may use the evaluation codes. CMS clarified that SLPs should use 92507 for reporting auditory rehabilitation.
Since CMS undervalued the auditory rehabilitation status evaluation codes, ASHA is seeking revision of the RVU so the fee for the hour’s time is appropriately established. CMS has also mistakenly set the value (0.55 for practice expense RVU) so that each additional 15-minute unit is worth the same relative value as the first hour.
SLPs must use 92506 for all cognitive communication evaluations beginning Jan. 1, 2006. CPT 96115 has been replaced by a new procedure code (96116) that specifies use by psychologists or physicians only. ASHA’s Health Care Economics Committee (HCEC) will work to establish use of this code by SLPs when performing evaluations that are primarily cognitive-communicative in nature.
Telepractice Services
CMS is also considering ASHA’s suggestions as the agency develops recommendations to Congress on what types of telepractice services should be covered under Medicare. Congressional action is needed to allow the inclusion of audiology and speech-language pathology telepractice services. In formal comments to CMS, ASHA described successful audiology applications occurring in (1) intraoperative monitoring, (2) audiologic diagnostics, (3) vestibular function testing, (4) aural rehabilitation, and (5) fitting of digital hearing aids.
ASHA also encourages CMS to consider telepractice applications for speech-language pathology services and described successful applications occurring in (1) aphasia, (2) voice, (3) cognitive-communication, (4) articulation, and (5) motor speech disorders. One example submitted by ASHA was an Oklahoma-based provider that rendered over 1,300 speech-language pathology telehealth treatment sessions over a three-year period. Legislation has been introduced (S. 1909) that would expand the definition of telehealth services to include SLPs.
The overall impact of the 2006 MPFS on audiologists and SLPs will depend on whether the budget reconciliation bill becomes law. CMS has already sent instructions on the 2006 MPFS to its contractors, which generally take several months to implement the new rates. Any changes in the MPFS made as a result of the budget reconciliation process will also take time to implement. Watch The ASHA Leader for continuing coverage.
Marat Moore contributed to this report.
* CPT © 2004 American Medical Association. All Rights Reserved.
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December 2005
Volume 10, Issue 17