Surveys Vital for Fair Reimbursement This year, new Current Procedural Terminology (CPT) procedures dealing with cochlear implants, dysphagia evaluations, and augmentative and alternative communication (AAC) devices submitted by an ASHA committee won the approval of the CPT editorial committee of the American Medical Association (AMA). Before these procedures are implemented, they must be assigned relative ... Bottom Line
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Bottom Line  |   March 01, 2002
Surveys Vital for Fair Reimbursement
Author Notes
  • Walter J. Smoski, is associate professor of audiology at Illinois State University and vice chair of ASHA’s Health Care Economics Committee.
    Walter J. Smoski, is associate professor of audiology at Illinois State University and vice chair of ASHA’s Health Care Economics Committee.×
Article Information
Practice Management / Bottom Line
Bottom Line   |   March 01, 2002
Surveys Vital for Fair Reimbursement
The ASHA Leader, March 2002, Vol. 7, 1-17. doi:10.1044/leader.BML1.07052002.1
The ASHA Leader, March 2002, Vol. 7, 1-17. doi:10.1044/leader.BML1.07052002.1
This year, new Current Procedural Terminology (CPT) procedures dealing with cochlear implants, dysphagia evaluations, and augmentative and alternative communication (AAC) devices submitted by an ASHA committee won the approval of the CPT editorial committee of the American Medical Association (AMA).
Before these procedures are implemented, they must be assigned relative values. For that part of the process, ASHA needs to report clinician time, equipment, and supplies for each procedure speech-language pathologists and audiologists perform. This information can only come from practicing clinicians.
SLPs and audiologists with experience in these procedures are being sought to fill out surveys to provide the accurate, fee-related data that are essential for the development of resource-based values. (The procedures will not have codes until 2003, so information on the codes is not yet available.)
“With solid survey information, work and practice expense values can be determined that are easily defended during the question and answer sessions,” said Wayne Holland, chair of ASHA’s Health Care Economics Committee (HCEC).
“Poor survey data, on the other hand, yield values that are typically rejected, which means they have to be resurveyed and resubmitted at a later time,” he added. “During that period, there will be no standard value for the procedure—and if an interim value is not applied, it’s possible that the procedure may not be compensated at all.”
How Medicare Outpatient Rates Are Developed
The development of CPT procedures is a lengthy and deliberative process. In 1991, the AMA formed the Relative Value Scale Update Committee (RUC) to make recommendations to the Centers for Medicare and Medicaid Services (CMS) concerning the relative values assigned to CPT procedures. The committee is composed of 28 members, of whom 23 are appointed by national medical specialty societies. Non-physicians have a seat on the RUC through the Health Care Professions Advisory Committee, on which ASHA has a seat. The RUC reviews information submitted mostly by health care specialty societies to develop relative values for CPT procedures.
Components of the relative value scale include:
  • amount of physician work

  • practice costs, including non-physician expense, time, equipment, supplies, and overhead

  • professional liability or malpractice costs

The work values are intended to rate the typical evaluation or treatment procedure length so that the easier or more difficult encounters with a procedure become balanced. The values accepted by the RUC are then sent to CMS for review. Typically, over 90% of the values sent to CMS are accepted and become a factor in the calculation that sets the Medicare outpatient fee for each approved CPT code.
For example, the CPT code 92506 is the code for speech, language, and aural rehabilitation evaluation, and it has a total relative value in 2002 of 2.62. In 2002, this relative value was multiplied by a CMS conversion factor of $36.1992, yielding a Medicare fee of $94.84. Geographical factors may slightly alter this value.
“We must provide the RUC accurate information concerning the work and expense for each CPT procedure performed. If we don’t, audiologists and SLPs won’t receive fair reimbursement, ”said Robert Fifer of the HCEC.
Using customized survey instruments developed by the AMA, the specialty societies are typically required to survey at least 30 practitioners, who are asked to use a selected list of services as reference points. The specialty society conducts the surveys, reviews the results, and prepares the recommendations for the RUC.
The new procedures just approved by the CPT editorial board will now be submitted to the RUC for value assignment. In this phase, the HCEC must collect survey information for each new procedure.
The AMA’s survey requires the clinician to follow a vignette describing a typical patient receiving the procedure, and assign work values and practice expense values to the described procedure.
Once the survey information is received, the HCEC uses the information to prepare recommendations to the RUC.
Any administrator or practitioner who is interested in completing a survey in the areas of cochlear implants, dysphagia evaluations (including FEES and FEESST), or AAC should contact Steven White through the Action Center at 800-498-2071, ext. 4126, or by email at swhite@asha.org.
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FROM THIS ISSUE
March 2002
Volume 7, Issue 5