Congress Tackles Medicare Fee Cuts The U.S. House of Representatives passed legislation (H.R. 3961) in November that would avert a scheduled 21.2% fee cut in the 2010 Medicare Physician Fee Schedule, but the Senate failed to pass a similar bill (S. 1776), unable to garner the 60 votes needed to bring it to debate on ... Policy Analysis
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Policy Analysis  |   December 01, 2009
Congress Tackles Medicare Fee Cuts
Author Notes
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
  • Neela Swanson, health care finance information coordinator, can be reached at nswanson@asha.org.
    Neela Swanson, health care finance information coordinator, can be reached at nswanson@asha.org.×
  • Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.
    Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   December 01, 2009
Congress Tackles Medicare Fee Cuts
The ASHA Leader, December 2009, Vol. 14, 1-4. doi:10.1044/leader.PA.14162009.1
The ASHA Leader, December 2009, Vol. 14, 1-4. doi:10.1044/leader.PA.14162009.1
The U.S. House of Representatives passed legislation (H.R. 3961) in November that would avert a scheduled 21.2% fee cut in the 2010 Medicare Physician Fee Schedule, but the Senate failed to pass a similar bill (S. 1776), unable to garner the 60 votes needed to bring it to debate on the Senate floor.
The 2010 fee schedule, recently released by the Centers for Medicare and Medicaid Services (CMS), includes the dramatic cut for all health care practitioners, including audiologists and speech-language pathologists, who provide Medicare Part B services. The schedule includes a cut of 21.2% in the “conversion factor,” a critical value in the fee formula, from $36.0666 to $28.4061.
The reductions stem from a provision in the Medicare law, known as the sustainable growth rate (SGR), which mandates an adjustment to the conversion factor when total Medicare physician expenditures in the prior year exceed a target.
However, Congress has taken last-minute action in each of the last seven years by passing a one-year “fix” that prevented the SGR-based adjustment and the resultant fee reductions. H.R. 3961 and S. 1776 call for CMS to replace the formula with a new payment update system; the Senate failed to pass its bill over concerns that it would increase the budget deficit by an estimated $89 billion over the next 10 years.
The recently released Senate health care proposal includes a one-year fix, with a 0.5% increase for 2010; given the unlikelihood that health care reform legislation will pass by the end of the year, however, there is speculation that Congress will provide for a temporary payment freeze as part of an end-of-year omnibus bill. ASHA—along with other medical organizations—is actively lobbying Congress to prevent the reductions.
If Congress does not intervene by year’s end, the 21.2% reduction would take effect Jan. 1, 2010. The effects of the 21.2% reduction and the proposed 0.5% increase on four procedure codes are illustrated in Table 1 [PDF].
Audiology RVUs
Even with an increase in the conversion factor, 2010 fees for some audiology codes will decrease, the unfortunate result of reductions in the relative value units (RVUs) assigned to these codes. RVUs, the second factor in the fee-setting formula, include three components: physician work (professional component), practice expense (technical component), and malpractice expense. Fees are established for each procedure by multiplying its total RVUs by the conversion factor. The audiology code reductions are attributable to several factors, including a new method for calculating practice expense and malpractice expense values and the shift from practice expense to physician (i.e., professional) work for the audiologist’s time.
CMS accepted the American Medical Association’s Specialty Society Relative Value Scale Update Committee’s (RUC) professional work values for the three new audiology bundled procedure codes (see The ASHA Leader, Nov. 24). In 2010, professional component values are 1.50 for 92540, basic vestibular evaluation; 0.35 for 92550, tympanometry and reflex threshold measurements; and 0.55 for 92570, acoustic immittance testing.
Speech-Language Pathology RVUs
The RUC reviewed four speech-language pathology procedures because the profession’s services are now reflected in the professional component—rather than the practice expense—following the change in direct billing status for SLPs. CMS accepted the RUC’s recommendations for all but one procedure—92597, voice prosthetic device evaluation. The changes in the RVUs for all four procedures are shown in Table 2 [PDF].
Audiology Timed Codes
CMS cautions audiologists on calculating time attributed to the five timed audiology evaluation codes; CMS accepted the professional component RVUs for these codes in the 2009 fee schedule. CMS stresses that activities such as counseling, establishment of interventional goals, or evaluating potential for remediation are not included as diagnostic tests, and that time spent on these activities should not be included in billing for:
92620 (evaluation of central auditory function, with report; initial 60 minutes)
92621 (evaluation of central auditory function, with report; each additional 15 minutes)
92626 (evaluation of auditory rehabilitation status; first hour)
92627 (evaluation of auditory rehabilitation status; each additional 15 minutes)
92640 (diagnostic analysis with programming of auditory brainstem implant, per hour).
Therapy Cap
The Medicare combined speech-language pathology and physical therapy cap will be $1,860 for 2010. The current exceptions process for the cap expires at the end of 2009 unless Congress acts to extend it (as it has for many years). An end-of-year omnibus bill is expected to include an extension for 2010.
Quality Reporting
For 2010, private-practice audiologists and SLPs enrolled as Medicare providers will be able to participate in the Medicare Physician Quality Reporting Initiative (PQRI) program, a voluntary program designed to improve the quality of care to Medicare beneficiaries (see The ASHA Leader, Nov. 24). Private-practice health care professionals who participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment. The 2010 fee schedule contains three audiology measures and eight speech-language pathology measures.
Audiologists will be able to report on three measures that call for referral of patients to a physician after an audiological evaluation finds one of three conditions: congenital or traumatic deformity of the ear, history of active drainage from the ear within the previous 90 days (for patients who have disease of the ear and mastoid processes), or history of sudden or rapidly progressive hearing loss. The Audiology Quality Consortium, a coalition of 10 audiology organizations, has developed a list of frequently asked questions for audiologists interested in learning more about the PQRI program.
SLPs will be able to report outcomes for stroke patients in eight functional domains: spoken language comprehension, reading, spoken language expression, writing, motor speech, swallowing, attention, and memory.
A complete analysis of the 2010 Medicare Physician Fee Schedule is available on the ASHA Web site. For further information or questions about the Medicare fee schedule, please contact reimbursement@asha.org.
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December 2009
Volume 14, Issue 16