Contact your local Medicare contractor for enrollment inquiries. You may choose one of two ways to submit your enrollment application: Internet-Based: CMS prefers that SLPs use the Provider Enrollment Chain & Ownership System (PECOS), an Internet-based scenario-driven application.
Full Answer
Does Medicare pay for speech pathology services?
Medicare Part B (Medical Insurance) helps pay for Medically necessary outpatient speech-language pathology services if your doctor or other health care providers certifies you need it. Your costs in Original Medicare You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Can independent speech-language pathologists provide services in a skilled nursing facility?
Can independent speech-language pathologists provide services in a skilled nursing facility (SNF)? Yes, however, speech-language pathology services are billed to Medicare by the SNF for Part A and Part B residents. A contract specifying payment terms should be executed between the speech-language pathologists and the facility.
How should a speech-language pathologist handle reimbursement?
If the reimbursement is from a private insurance company the speech-language pathologist should refer to the contract between the provider and the health plan. If no such contract exists, the professional should contact the payer for clarification.
What is the CPT code for speech therapy?
The officials contend that procedures such as speech-language pathology treatment (92507) and dysphagia treatment (92526) are bundled codes and encompass all elements of a therapy service. CPT code 92507 (speech-language treatment) is very comprehensive and generally includes all components of treatment.
What is a CMS 8550 form?
CMS 855O. Form Title. Medicare Enrollment Application - Registration For Eligible Ordering and Referring Physicians and Non-Physician Practitioners.
What is an 855B Medicare form?
CMS 855B. Form Title. Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers. Revision Date.
What is CMS 855I application?
❖ 855I. • CMS form which enrolls physicians and non-physician practitioners who. render Medicare Part B services to beneficiaries. • Enrolls practitioners who are the sole owner of a professional corporation. and bill Medicare through this business entity.
When did SLPs direct bill Medicare?
Policy: SLPs in private practice may begin the Medicare enrollment process on June 2, 2009.
What is the difference between 855A and 855B?
The following forms can be used for initial enrollment, revalidations, changes in status, and voluntary termination: CMS-855A for Institutional Providers. CMS-855B for Clinics, Group Practices, and Certain Other Suppliers. CMS-855I for Physicians and Non-Physician Practitioners.
What is an 855 application?
CMS-855I. Physicians and Non-Physician Practitioners. Physicians and non-physician practitioners can apply for enrollment in the Medicare program or make a change in their existing enrollment information using the CMS-855I.
How do I fill out CMS 855I form?
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Where can I get form 855I?
For additional information regarding the Medicare enrollment process, including Internet-based PECOS and to get the current version of the CMS-855I, go to http://www.cms.gov/MedicareProviderSupEnroll.
How do I submit my Pecos 855R?
Providers and suppliers are able to submit their reassignment certifications either by signing section 6A and 6B of the paper CMS-855R application or, if completing the reassignment via Internet-based PECOS, by submitting signatures electronically or via downloaded paper certification statements (downloaded from www. ...
How do I bill a Medicare speech pathologist?
SLPs may use 97000 series CPT codes—if appropriate. Under Medicare, SLPs may use CPT codes 97129 (cognitive function intervention, initial 15 minutes) and 97130 (cognitive function intervention, each additional 15 minutes) when treating cognitive disorders.
Is speech therapy covered under Medicare?
Medicare Part B covers medically necessary speech-language therapies when provided by qualified healthcare practitioners. Both short- and long-term options may be covered.
How do I bill Medicare Part B?
Talk to someone about your premium bill For specific Medicare billing questions: Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. For questions about your Part A or Part B coverage: Call Social Security at 1-800-772-1213. TTY: 1-800-325-0778.
How many coding systems are there for Medicare?
There are three major coding systems used when submitting claims for reimbursement by Medicare. Below are links to speech-language pathology related codes compiled from each of the major coding systems:
What is the CMS 1500 form?
Medicare billing is coordinated through your local Medicare contractor, however, the standard form used for submitting claims is called the CMS 1500 Health Insurance Claim Form [PDF]. For step-by-step instructions on completing and processing the CMS 1500 form, go to Chapter 26 of the Medicare Claims Processing Manual [PDF].
What is the Medicare Benefit Policy Manual?
The Medicare Benefit Policy Manual provides general coverage rules and regulations for providers of Medicare services. Specifically, Chapter 15, Section 220-230.6 [PDF] of the manual addresses the rules and regulations related to therapy services (speech-language pathology, physical therapy, and occupational therapy) provided in an outpatient setting.
Does Medicare have coding rules?
Medicare Coding Rules. Medicare has very specific rules regarding coverage of certain codes and services . ASHA has compiled Medicare coding rules related to speech-language pathology services, however, you should also be aware of local coverage determinations (LCDs) from Medicare contractors that are specific to your locality.
Does Medicare pay for speech pathology?
Speech-language pathology services under Medicare Part B have reimbursement rates established by the Medicare Physician Fee Schedule regardless of provider setting. Payment is determined by the fee associated with a specific procedure code (see Coding for Reimbursement) in those settings. The fee schedule is updated annually.
What is the first step for speech pathologists?
As a first step, speech-language pathologists interested in enrolling in the Medicare program should obtain a National Provider Identifier (NPI), if they have not already done so. CMS offers more information on the NPI, including a general overview and how to apply.
Can a clinician collect co-payments from Medicare?
Once approved, in most circumstances, the clinician must submit claims to Medicare and can only collect applicable co-payments and deductibles from Medicare beneficiaries. For additional information, see ASHA's guidance regarding Medicare enrollment requirements [PDF].
Do you have to bill Medicare for outpatient services?
If you are providing outpatient services to patients who qualify for Medicare—by virtue of age or disability—under Part B of the Medicare program and you are working in a clinic, office, or private practice setting, federal law requires you to enroll in and bill the Medicare program for covered services provided to Medicare beneficiaries.
Is speech language pathology covered by Medicare?
Speech-language pathologists in private practice will be reimbursed based on the Medicare Physician Fee Schedule (MPFS). ASHA's annual analysis of the MPFS rules provides information on procedures specific to speech-language pathologists related to the Medicare fee schedule.
Can speech pathologists be billed by Medicare?
However, the place of service (POS) code on the claim form should reflect where the service was delivered. Additionally, speech-language pathologists should keep in mind that transportation costs—such as gas or time spent traveling to the patient's home —cannot be billed to Medicare.
Can private practitioners bill Medicare?
No. Those services are bundled into the prospective payment to the institution or paid to the home health agency per episode of care. Private practitioners can contract with hospitals, SNFs, or home health agencies, but the facilities are required to bill Medicare directly.
Can speech language pathologists be a Medicare provider?
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 allows speech-language pathologists to enroll as a Medicare provider. A physician order or referral is not required (unless required under state law), although the physician must approve the plan of care within 30 days and periodically thereafter.
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Medicare law no longer limits how much it pays for your medically necessary outpatient therapy services in one calendar year.
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To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
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Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
How long does it take for a speech pathologist to recertify a plan of care?
If the plan of care is written by the speech-language pathologist, it must be certified by the patient's physician within 30 days. For outpatient services, the plan of care must be recertified by the physician every 90 days from ...
How often do you have to recertify a plan of care?
For outpatient services, the plan of care must be recertified by the physician every 90 days from the initiation of treatment or when there is a significant modification to the plan. The physician must review the plan of care every 60 days for home health agencies and Comprehensive Outpatient Rehabilitation Facilities.
What is the code for cognitive function intervention?
Medicare policy specifically allows speech-language pathologists to use 97129 (cognitive function intervention, initial 15 minutes) and 97130 (cognitive function intervention, each additional 15 minutes) for treatment of cognitive disorders, but notes that either code 92507 or 97129/97130 could be used, but not both for the same treatment.
Why do not use other physical medicine codes?
Additionally, officials at the Centers for Medicare and Medicaid services do not support the use of other physical medicine codes because the vignettes (examples of the procedures performed with a typical patient) used reflect physical therapy or occupational therapy.
Can a speech pathologist change a plan of care?
The physician or speech-language pathologist can make changes in the plan of care. The speech-language pathologist may not significantly alter a plan of care without recertification from the physician. Medicare requirements for a plan of care are set forth in the Medicare Benefit Policy Manual, Chapter 15, Section 220.1.2 [PDF].
Is speech language pathology covered by Medicare?
Services of speech-language pathology assistants are not recognize d for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services. Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare. Although an aide may help the therapist by providing unskilled services, those services are not covered by Medicare and shall be denied as not reasonable and necessary if they are billed as therapy services.
Is a therapist covered by Medicare?
Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare. Although an aide may help the therapist by providing unskilled services, those services are not covered by Medicare and shall be denied as not reasonable and necessary if they are billed as therapy services.
How long does it take to become a Medicare provider?
You’ve 90 days after your initial enrollment approval letter is sent to decide if you want to be a participating provider or supplier.
How to get an NPI for Medicare?
Step 1: Get a National Provider Identifier (NPI) You must get an NPI before enrolling in the Medicare Program. Apply for an NPI in 1 of 3 ways: Online Application: Get an I&A System user account. Then apply in the National Plan and Provider Enumeration System (NPPES) for an NPI.
How to change Medicare enrollment after getting an NPI?
Before applying, be sure you have the necessary enrollment information. Complete the actions using PECOS or the paper enrollment form.
How to request hardship exception for Medicare?
You may request a hardship exception when submitting your Medicare enrollment application via either PECOS or CMS paper form. You must submit a written request with supporting documentation with your enrollment that describes the hardship and justifies an exception instead of paying the application fee.
What are the two types of NPIs?
There are 2 types of NPIs: Type 1 (individual) and Type 2 (organizational). Medicare allows only Type 1 NPIs for solely ordering items or certifying services. Apply for an NPI in 1 of 3 ways:
What is Medicare Part B?
Medicare Part B claims use the term “ordering/certifying provider” (previously “ordering/referring provider”) to identify the professional who orders or certifies an item or service reported in a claim. The following are technically correct terms:
What is Medicare revocation?
A Medicare-imposed revocation of Medicare billing privileges. A suspension, termination, or revocation of a license to provide health care by a state licensing authority or the Medicaid Program. A conviction of a federal or state felony within the 10 years preceding enrollment, revalidation, or re-enrollment.
How to become a Medicare provider?
Become a Medicare Provider or Supplier 1 You’re a DMEPOS supplier. DMEPOS suppliers should follow the instructions on the Enroll as a DMEPOS Supplier page. 2 You’re an institutional provider. If you’re enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution, you should use the Medicare Enrollment Guide for Institutional Providers.
How to get an NPI?
If you already have an NPI, skip this step and proceed to Step 2. NPIs are issued through the National Plan & Provider Enumeration System (NPPES). You can apply for an NPI on the NPPES website.
How long does it take to change your Medicare billing?
To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days: a change in ownership. an adverse legal action. a change in practice location. You must report all other changes within 90 days. If you applied online, you can keep your information up to date in PECOS.
Do you need to be accredited to participate in CMS surveys?
ii If your institution has obtained accreditation from a CMS-approved accreditation organization, you will not need to participate in State Survey Agency surveys. You must inform the State Survey Agency that your institution is accredited. Accreditation is voluntary; CMS doesn’t require it for Medicare enrollment.
Can you bill Medicare for your services?
You’re a health care provider who wants to bill Medicare for your services and also have the ability to order and certify. You don’t want to bill Medicare for your services, but you do want enroll in Medicare solely to order and certify.
What is Medicare Administrative Contractor?
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.
What is speech pathology?
Speech-language pathology services are those services provided within the scope of practice of speech-language pathologists and necessary for the diagnosis and treatment of speech and language disorders, which result in communication disabilities and for the diagnosis and treatment of swallowing disorders (dysphagia), regardless of the presence of a communication disability. (See Pub. 100-03, chapter 1, §170.3)See section 230.4 of this chapter for benefit policies on speech-language pathologists in private practice (SLPP). See Pub. 100-08, Medicare Program Integrity Manual, chapter 10, section 12.4.14 for policy on enrollment in an SLPP.
What is a TPP therapist?
Therapist refers only to a qualified physical therapist, occupational therapist or speech-language pathologist. TPP refers to therapists in private practice ( qualified physical therapists, occupational therapists and speech-language pathologists).
Is speech language pathology a Medicare insured?
Services of speech-language pathology assistants are not recognized for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services.
Classifications
The Internal Revenue Service uses three categories to determine the classification of a worker.
Making the switch
So, what if you find yourself in the position I was in nine years ago—suddenly realizing that your ICs are actually employees? First, don’t panic. The process to correct it isn’t complicated, but it takes some time and planning. Before announcing that you will convert everyone from IC to employee status, there are a few ducks you need to line up.
Advantages
Don’t let the prospect of bringing clinicians on as employees scare you—the results can be advantageous.