Eli's Rehab Report

Published on Wed Sep 10, 2008 PDF

A lucky provision in the MIPPA legislation gives SLPs the ticket.

If you're a speech-language pathologist in private practice, you're in luck. The recently passed Medicare Improvements for Patients and Providers Act (H.R. 6331) included a provision giving SLPs in private practice the ability to enroll in the Medicare program, effective July 1, 2009.

"This bill brings us up to parity with the other two rehab disciplines," cheers Ingrida Lusis, director of federal policy and advocacy for the American Speech-Language Hearing Association. But even more important, "beneficiaries in rural and underserved areas will have better access to SLP services."

You have about a year until your billing status goes live, but you'll need that time to complete the paperwork necessary to participate in the Medicare program. For starters, you must go through the Medicare enrollment process, Lusis says, which involves filling out a CMS-855 form.

For more information on what's involved in this process, see the article "Are You On Your Revalidation Process Game?" in Physical Medicine & Rehab Coding Alert Vol. 9, No. 6. You can also access more information on Medicare provider enrollment, as well as the 855 form, at http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf.

Next step: You'll need to obtain a National Provider Identifier (NPI) number if you don't already have one. This will be your ticket to filing your claims with Medicare. The enrollment window will probably be sometime late next spring so SLPs can start billing July 1, Lusis says.

Good idea: If you've been working in a facility setting and want to open a private practice, make sure you're up to speed on billing and coding issues -- or anything else the facility may have taken care of, Lusis suggests.

Wish you could participate in PQRI? Wish no more. Private practice status opens the door for SLPs to participate in the Physician Quality Reporting Initiative (PQRI). In addition, the MIPPA legislation allows audiologists to bill under the PQRI, Lusis says. "We're working with CMS on what measures would apply to SLPs and audiologists, and we're pushing for CMS to consider some measures in ASHA's outcomes tool, National Outcomes Measurement System (NOMS), for the purpose of PQRI."

Stay tuned: CMS still has to write regulations and release manual guidance for SLPs in private practice. The agency also updates PQRI guidance in the fall, so be on the lookout for both.

For information now on getting started in Medicare provider enrollment, ASHA has developed a Web site to address basic questions at http://www.asha.org/members/issues/reimbursement/medicare/medicarefaqslpprivateprac.htm.