Effort Builds for “Fair and Equitable” Reimbursement: Health Care Economics Committee Prepares for AMA’s Coding Review On April 22–23, ASHA’s Health Care Economics Committee (HCEC) met to prepare for the first review of physician work related to audiology and speech-language pathology codes in five years by the American Medical Association’s Relative Update Committee (RUC). It is anticipated that the review will begin later this year. The ... ASHA News
Free
ASHA News  |   May 01, 2005
Effort Builds for “Fair and Equitable” Reimbursement: Health Care Economics Committee Prepares for AMA’s Coding Review
Author Notes
  • Marat Moore, managing editor of The ASHA Leader, can be reached at mmoore@asha.org.
    Marat Moore, managing editor of The ASHA Leader, can be reached at mmoore@asha.org.×
Article Information
Practice Management / ASHA News
ASHA News   |   May 01, 2005
Effort Builds for “Fair and Equitable” Reimbursement: Health Care Economics Committee Prepares for AMA’s Coding Review
The ASHA Leader, May 2005, Vol. 10, 1-21. doi:10.1044/leader.AN1.10072005.1
The ASHA Leader, May 2005, Vol. 10, 1-21. doi:10.1044/leader.AN1.10072005.1
On April 22–23, ASHA’s Health Care Economics Committee (HCEC) met to prepare for the first review of physician work related to audiology and speech-language pathology codes in five years by the American Medical Association’s Relative Update Committee (RUC). It is anticipated that the review will begin later this year.
The recognition of the “physician work” component in the Medicare payment system is the most pressing reimbursement issue to face audiology and speech-language pathology, and could shape the future of Medicare reimbursement to the professions. Currently the valuation of most audiology and speech-language pathology procedures is based primarily on time. Adding the “work” component would mean that essential factors such as technical skill, judgment, and psychological stress would be a part of the valuation formula.
“Presently we are considered practice expense only, and are categorized the same as nurses, technical staff, and other physician support personnel,” said Robert Fifer, an audiologist and member of ASHA’s Health Care Economics Committee.
The HCEC-with five audiologists and five SLPs, all experts in reimbursement-has emerged as a leader in the effort for reimbursement equity for audiology and speech-language pathology. Since 2000, the HCEC has been responsible for successfully adding 17 new Current Procedural Terminology (CPT, © American Medical Association, 2004) codes for ASHA members.
ASHA is the official representative for the professions to the AMA’s Health Care Professional Advisory Committees to the CPT editorial panel and the RUC, and created the HCEC to plan strategy on coding issues and gather input from other organizations to assure adequate representation of the professions.
Collaboration on Codes
Representatives from nearly a dozen audiology and speech-language pathology organizations traveled or called in to the ASHA National Office on April 23 to give input on procedural coding changes that are needed and to explore approaches in dealing with those changes.
On profession-specific issues, the committee, with its five audiologists and five SLPs, divided into subcommittees.
The audiology subcommittee met with representatives of five other audiology organizations: American Academy of Audiology; Academy of Dispensing Audiologists; Academy of Federal Audiologists and Speech-Language Pathologists; Association of VA Audiologists; and Military Audiology Association.
Some of the coding needs identified included a new family of balance codes that reflect the change in practice and new technology, which uses an optic recording of eye movement, and codes for vestibular therapy. They also discussed changes that might be addressed in the future, such as developing non-reimbursable codes that could be used to track productivity. They also reviewed procedures that are rarely reported, such as the Lombard test. In addition to code development planning, the groups also discussed ways to increase collaboration in efforts to educate members about coding and reimbursement.
“We were pleased to be involved with other audiology organizations in discussing future plans for code requests and also the sharing of mutual reimbursement concerns,” noted Deborah Abel, a member of AAA and ADA who chairs AAA’s coding and practice management committee.
The speech-language pathology subcommittee met with representatives from National Association for the Support of Long Term Care, American Cleft Palate-Craniofacial Association, American Academy of Private Practice in Speech Pathology and Audiology, Academy of Federal Audiologists and Speech-Language Pathologists, Association of VA Speech-Language Pathologists, and United States Association for Augmentative and Alternative Association. The group discussed the need to revise the evaluation and treatment codes to more accurately reflect the way in which service is provided. The impediment to making changes at this time is that SLPs’ work is not recognized as “physician work.”
A representative from the Centers for Medicare and Medicaid Services (CMS) also attended the HCEC meeting to share information and answer questions. Two possible alternatives to the $1,500 Medicare cap on outpatient rehabilitation are being explored by CMS, a global approach that would attempt to use the current payment systems with edits to place limits on spending and a Pay for Performance (known as P4P) approach.
P4P ties payment for providers (hospitals, physicians, and practitioners) to the outcome of care-in other words, to their performance. The concept is in its infancy with a few CMS demonstration projects underway. Other payers will be very interested in this as it develops and the committee will follow this closely.
The CMS official also indicated that a revised Benefit Policy Manual will be released soon and will deal with issues such as medically reasonable and necessary, certification/re-certification, and provider qualifications. When the manual is released, ASHA plans to hold a teleconference to share the new information.
Moving Ahead
To make progress in the area of Medicare reimbursement, the importance of recognition of the “physician work” in valuation cannot be overstated, says committee chair Nancy Swigert.
“Until we achieve this recognition in the Medicare formula, we cannot move forward with revisions to current codes or the development of new codes. The risk is too high that the codes would be undervalued,” said Swigert, an SLP.
“This lack of recognition of ‘work’ is the sole reason we have not been able to propose a 15-minute therapy code for speech-language pathology.”
She noted that the AMA recognizes the work of physical therapists and occupational therapists.
“It’s time that our work was recognized. We’re independently practicing professionals who perform the procedure and interpret the results for the purposes of functional communication and related disorders,” she said.
“We are hopeful that CMS will collaborate with the RUC so that we will have our professional services appropriately addressed.” Swigert said that the work of SLPs and audiologists can be differentiated from that of physicians and valued in a separate manner.
Noted Fifer, “We’re paid from a pool of money that was established to be a temporary measure until CMS could develop another reimbursement formula that would be fair and equitable to us and some services rendered by radiology, oncology, and other specialties.
“The pool of money from which we are reimbursed today will probably go away sometime over the next two to three years based on current information. If our codes leave that pool without an appropriate replacement formula for reimbursement, then we face the risk of a significant decrease in reimbursement, and we’ll do everything in our power to prevent that from happening.”
The HCEC meets again in September and welcomes input from members about coding and reimbursement issues. Contact reimbursement@asha.org.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
May 2005
Volume 10, Issue 7