Clinical Q & A
ASHA G Codes
Medicaid Billing &
Reimbursment Handout (pdf)
Vice President for Clinical Services
Heather Lazarides, MS, CCC-SLP
Update March 2013
Who Moved My Cheese? is a very good book regarding change. The therapy world is changing every day. Just when I think I have a good handle on the Medicare changes …things change yet again. With that in mind, I have a couple of changes to inform you about.
First, those of you treating Part B Medicare patients should be seeing another change. Starting January 1, 2013, therapists should begin to report patient outcomes on their claim forms. This requirement went into effect on January 1, 2013, however, penalties for not using the outcomes will not begin until July 1, 2013. This is the most significant change of the SLP related provisions in the 2013 Medicare Physician Fee Schedule and contains regulations related to reimbursement, reporting requirements, procedure codes and other Medicare provider issues. ASHA reported: SLPs who provide services to Medicare Part B fee for services patients in all settings must report on patient progress and outcomes using G-codes on claim forms. This new requirement is an effort by the Center for Medicare and Medicaid Services (CMS) to collect data that may be used to create a new Medicare reimbursement system for therapy services. CMS will reject claims that do not include the required information.
SLPs must report on seven functional communication measures or one generic measure. The measure, adopted from ASHAs National Outcomes Measurement System (NOMS) is described as a G-code with a seven point severity modifier system that corresponds to the NOMS functional communication measures. The SLP must report one functional communication measure for every Medicare Part B beneficiary at admission, discharge and every 10th treatment day. The codes must be documented in the medical record as well. Although the rule mandates reporting to start January 1, 2013, the first six months will be considered a transition period. Beginning July 1, 2013, claims without the codes will be returned unpaid.
ASHA does offer two free CEU’s for taking the NOMS training course located on the ASHA web site. The codes and reporting instructions can be found here.
In addition, on Wednesday January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012 – the new law includes Physician Update fix through December 2013. These are the highlights:
Scheduled 26.5% Medicare Physician Fee Schedule (MPFS) Cut Averted
- The new law provides for a zero percent update for such services from January 1 through December 31, 2013. The Centers for Medicare and Medicaid Services (CMS) is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November.
- The 2013 conversion factor is $34.0230.
Medicare Outpatient Therapy Services Therapy Caps
- Section 603 extends the automatic and manual exceptions process for outpatient therapy caps through December 31, 2013.
- The 2013 cap limit for PT/ST combined is $1,900 and the separate OT cap is $1,900.
- The Manual preapproval threshold for each cap remains at $3,700.00.
- Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services furnished through December 31, 2013.
- Finally, the new law extends the application of the cap and threshold to therapy services furnished in hospital outpatient departments and counts outpatient therapy services furnished in a Critical Access Hospital toward the cap and threshold.
The following areas are some of the areas addressed by
the Clinical Services/Affairs section of MSHA:
- Reimbursement Issues with Medicare, Medicaid, and Private Insurance
- Minority Student Leadership Program
- Member Education
- Clarification of CPT Codes and Billing
- Licensure Issues
- Assistance with interaction with other professionals about the
services we provide and our Scope of Practice
- STAR Representative to ASHA
- Consumer Advocacy
- Health Insurance Advocacy
Language/Cognitive Disorder - Evaluation Summary
Evaluation of patient’s deficits indicated expressive aphasia.
This disorder was characterized by anomia (naming disorder). Patient
was unable to recall names of persons, places, and/or objects to
communicate basic and medical needs. Patient could, however, follow
simple directions and could recall the names of common objects when
compensatory techniques were introduced (paring of auditory/visual
stimuli) suggesting that the patient would benefit from skilled
intervention. Patient also demonstrated attention deficits which
made it difficult for patient to concentrate on evaluation materials.
Additional training and instruction will be needed to help patient
improve their ability to focus on therapeutic tasks so that language
skills can improve.
Progress Notes: Language/Cognitive Deficits
Visit One: Patient seen to improve word naming skills. Patient trained
in use of auditory and visual stimuli to facilitate verbal expression
related to medical needs. Additional training to improve attention
to therapeutic task provided (tactile cueing). Attentional training
procedures helped patient focus on auditory/visual stimuli and enabled
patient to recall names of body parts and medications necessary
for patient’s care.
Speech/Cognitive Deficits - Evaluation Summary
Patient’s deficits were characterized by moderate dysarthria
affecting ability to produce clear speech for basic and medical
needs. Tongue and lip strength and range of motion were not adequate
for production of understandable speech. Potential for improvement,
however, is positive since patient has partial control of tongue
and lip muscles and can follow directions. Additional deficits include
a mild cognitive disorder characterized by short term memory problems
and reasoning difficulties. Training and instruction in use of specific
compensatory strategies (visual aids and reduction in use of specific
compensatory strategies (visual aids and reduction in rate of word
and phrase presentation) should adequately address the cognitive
deficits so that the patient can benefit from training and instruction
to improve speech intelligibility for the expression of basic and
Progress Notes: Speech/Cognitive Deficits
ASHA’s State Advocates for Reimbursement (STARs) are appointed by State Speech-Language-Hearing Associations to act as advocates for improved health care coverage and reasonable reimbursement. The Missouri STAR is Heather Lazarides, MS, CCC-SLP, email@example.com.
ASHA’s State Advocates for Medicare Policy (StAMP) Network are appointed by State Speech-Language-Hearing Associations to act as advocates for Medicare coverage and reimbursement of audiology and speech-language pathology services in the states. The mission of the StAMP network is to enhance and perpetuate the advocacy, leadership and communication of ASHA members at the state level to influence administrative and public policy decisions that impact Medicare coverage and reimbursement of services. The Missouri StAMP is Heather Lazarides, MS, CCC-SLP, firstname.lastname@example.org.
Visit One: Patient seen to improve speech intelligibility related
to medical needs. Trained to increase tongue range of motion. Visual
aids introduced as necessary to compensate for short term memory
disorder. Pictures presented helped patient identify target tongue
positions in oral cavity. This resulted in improved pronunciation
of words beginning with /l/, /t/, and/d/ sounds (leg/teeth/doctor).