Reimbursement

Blue Cross Blue Shield of Massachusetts Announces Change to Retro Authorization Policy

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SLPs Are Invited to Join Our Medicare Advantage Networks

Based on recent federal legislation, SLPs will be eligible to participate in Medicare Part B starting in July 2009. As a result, SLPs who wish to join Blue Cross Blue Shield of Massachusetts' (BCBSMA's*) Medicare Advantage networks (Medicare HMO Blue® and Medicare PPO BlueSM) can apply for participation by following this process:

1. Apply for Medicare Part B participating provider status through the Centers for Medicare & Medicaid Services (CMS). CMS will accept applications for Medicare Part B participation starting June 2, 2009.
   
   
2. Complete and return the attached Contract Update Form for Speech-Language Pathologists (see the Resources section for information on obtaining an electronic copy of the form). You must also include a copy of your Medicare Part B participating provider letter from CMS. Therefore, please do not return this form before you receive your Medicare Part B participation from CMS. If you participate in a group, all SLPs in the group must apply and become a Medicare B participating provider and should complete and submit this form.
   
   
3. Complete and return the enclosed W-9 Form.
   
   
4. Upon receipt of your completed Contract Update Form for Speech-Language Pathologists and W-9, we will send you a BCBSMA Provider Services Agreement to complete, sign, and return. Once the Agreement has been executed, our Provider Enrollment area will send you a copy for your files and a letter indicating the effective date of your participation in our Medicare Advantage (Medicare HMO Blue and Medicare PPO Blue) networks. You cannot bill and be reimbursed for SLP services performed for Medicare Advantage members until the contracting process is completed and you have received notification from BCBSMA that you are participating in Medicare HMO Blue and/or Medicare PPO Blue.

If You Participate in a Group
If you participate in a group, all SLPs in that group need to complete and submit the Contract Update Form for Speech-Language Pathologists . As a reminder, any new employees who join your practice will need to complete the application process according to our standard practice. This includes completing a Speech-Language Pathologist Contracting Application and submitting it to BCBSMA for review.

Resources
Medicare Part B enrollment information: http://www.cms.hhs.gov/MedicareProviderSupEnroll and select the applicable link.

Contract Update Form for Speech-Language Pathologists
Log on to http://www.bluecrossma.com/provider and select News for You>FYIs . Click on the F.Y.I . dated May 1, 2009 (PC-1389). The form is a PDF within the F.Y.I. You can complete the form online. Print it out and return it to BCBSMA. Note that due to software limitations, you will not be able to save a copy of the form.

Questions?
If you have any questions, please e-mail ancillaryproviderrelations@bcbsma.com or call 1-800-316-BLUE (2583) and select Option 2 . As always, thank you for the care you provide to our members.

Posted 5/12/2009

Update on State Reimbursement  

As you know, Congress recently passed Medicare legislation that will allow SLPs in private practice to bill Medicare(see http://www.asha.org/members/issues/reimbursement/medicare/medicarefaqslpprivateprac ). ASHA is developing a number of resources for members, including an update of the Medicare Handbook for Speech-Language Pathologists. And for those who would like more information - there will be a live web/telephone seminar entitled "Medicare Billing for SLPs in Private Practice" scheduled for September 23rd that you should check
http://www.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsmainpage&utm_source=asha&utm_medium=toplink . This program will be moderated by Steve White from ASHA and will feature speakers Mark Kander, Ingrida Lusis and Janet Brown.

ASHA will continue to provide periodic updates with any other educational offerings about the new benefit. Of course, the 2008 ASHA Convention will have information about the change at the ASHA Center. The ASHA Health Care Economics Committee (HCEC) session (0186) "Health Care Economics: Its' Not Just Coding, It's Your Livelihood" will include considerable information about Medicare. Please note that even though the HCEC session is listed in the Audiology section of the ASHA Leader Convention Program, it is for both speech-language pathologists and audiologists.

Medicare Announces More Accurate Payments for Inpatient Rehabilitation Facilities

The Centers for Medicare and Medicaid Services (CMS) has announced that it has recalculated reimbursement rates for inpatient rehabilitation facilities (IRF) to more accurately reflect the intense rehabilitation services the facilities provide Medicare beneficiaries. Patients receiving services at inpatient rehabilitation facilities are often recovering from serious illnesses, such as stroke. The rates, which become effective October 1, 2008, are part of the IRF final rule which will be published in the August 8, Federal Register.

According to CMS, the payment rates set for rehabilitation therapy services provided in IRFs are higher than what would be paid for services in other settings, such as hospital outpatient departments, skilled nursing facilities, or in home health settings. This is because these patients have more severe and more complex medical conditions that need more intensive and coordinated rehabilitation services. The final rule also retains the requirement that at least 60 percent of a facility’s patient population have 1 of 13 qualifying conditions specified in Medicare regulations. As part of the final rule, CMS will continue to count patients whose principal reason for needing inpatient rehabilitation services is not one of the qualifying conditions, but whose treatment is complicated by the presence of one or more of these conditions, as a secondary diagnosis. For additional information on the IRF final rule, please contact reimbursement@asha.org.

ASHA STAR Network

posted 07/21/2008

To All Key Providers and Provider Society and/or Association Contacts:

Please be advised that on 5/23/2008, a number of providers, vendors, and clearinghouses migrated to full NPI compliance without testing. As a result, a significant volume of claims have been and continue to be forwarded to BCBSMA with errors in the taxpayer ID field. This field directs us to pay a specific entity and must be correctly and consistently correlated with the submitted NPI. After pending impacted claims for a period of time to research the root cause of the errors, we decided that in order to avoid payments to incorrect provider entities, BCBSMA would begin rejecting claims on 6/21/2007. These claims are being rejected with a specific message (X419) directing providers how to contact BCBSMA to resolve their specific issue.

BCBSMA has communicated with providers about this issue electronically,via the attached FYI (BCBSMA Reject Code FYI PC-1346) , and via the aforementioned rejection message. We are forwarding this information on to you to ensure you are aware of the situation, and to request your ongoing assistance in educating as many providers as possible about the problem and how it can be resolved if they are encountering it.

Please direct providers (if they need to update their information on file with BCBSMA) to call 800-419-4419.

posted 07/01/2008

New Medicare Speech-Language Pathology Rules Published

The Centers for Medicare & Medicaid Services (CMS) revised Chapter 15 of the Medicare Benefit Policy Manual, sections 220 and 230 that impact the provision of speech-language pathology services. The implementation date is June 9, 2008.

Billing for speech-language pathology services by a private practice occupational therapist or physical therapist: This provision has been deleted because many states do not allow services to be billed by practitioners who have no supervisory responsibility over the practitioner rendering the service. The contractors may interpret billing rules consistent with state and local policies. (230.3.B)

Long Term Treatment Goals: When the episode of care is anticipated to be longer than the certification/recertification period, the long-term goal may be specific to the part of the episode that is being certified. If the episode is short, measurable goals may not be achievable; documentation should state the clinical reasons progress cannot be shown. (220.1.2.B)

Treatment Duration/Frequency: CMS recognizes that, depending on the individual's needs, it may be most efficient and effective to provide short-term intensive treatment or longer term and less frequent treatment. When a tapered frequency of treatment is planned, the exact number of treatments per week is not required in the plan because changes should be made based on assessment of daily progress. (220.1.2.B)

Plan of Treatment Dates: Notation in the medical record of the beginning date is recommended but not required. This assists the Medicare contractor in determining the dates of service for which the plan was effective. (220.1.2.B)

Certification/Recertification: A physician/NPP may certify or recertify a plan for whatever duration of treatment the physician/NPP determines is appropriate, up to a maximum of 90 calendar days. Treatment beyond the duration certified by the physician/NPP requires that a plan be recertified for the extended duration of treatment. It is not required that the same physician/NPP who participated initially in recommending or planning the patient's care certify and/or recertify the plans. (220.1.2.C)

Physician/NPP Visits: If the physician wishes to restrict the patient's treatment beyond a certain date when the physician has determined that a visit is required, the physician should certify a plan only until the date of the visit. (220.1.2.C)

Delayed Certification: An example is given of a certified plan of care ending March 30th and a new plan of care for continued treatment after March 30th is developed or signed by a speech-language pathologist on April 15th and that plan is subsequently certified; that certification may be considered delayed and acceptable, effective from the first treatment date after March 30th for the frequency and duration as described in the plan. Documentation should continue to indicate that therapy during the delay is medically necessary, as it would for any treatment. (220.1.2.D)

Progress Reports: Clarification is made that the Progress Report Period is at least once every 10 treatment days or at least once during each 30 calendar days, whichever is less . Dates for recertification of plans of care do not affect the dates for required Progress Reports. (220.3.D)

Discharge Summary: In provider settings where the physician/NPP writes a discharge summary and the discharge documentation meets the requirements of the provider setting, a separate discharge note written by a therapist is not required. (220.3.D)

Signature of the Qualified Speech-Language Pathologist: Since a clinician must be identified on the Plan of Care and the Progress Report, the name and professional identification of the supervisor responsible for the treatment is assumed to be the clinician who wrote the plan or report. When the treatment is supervised without active participation by the supervisor, the supervisor is not required to cosign the Treatment Note written by a qualified professional. (220.3.E)

Speech-Language Pathologists as Employees or Contractors of Physician Practices: For outpatient speech-language pathology services that are provided incident to the services of physicians/NPPs, even though the requirement for speech-language pathology licensure does not apply; all other personnel qualifications do apply so that the individual must meet the education and experience required for the CCC-SLP or meet the educational requirements and be in the Clinical Fellowship. (230.3.B)

Aural Rehabilitation Scope of Coverage: The coverage category, "aural rehabilitation," is replaced by "Impairments of the Auditory System." Auditory processing coverage includes but is not limited to services for certain neurological impairments or the absence of natural auditory stimulation that results in impaired ability to process sound. (230.3.D.3)

The complete text of CMS Transmittal 88 is available on the CMS Web site at: http://www.cms.hhs.gov/transmittals/downloads/R88BP.pdf . For further information, please contact reimbursement@asha.org.

posted 07/03/09