February 2014 Newsletter


Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

February 2014

Happy Valentine’s Day!


The heart has its reasons of which reason knows nothing.

Start the year EDUCATED!  Lots of great CEU opportunities!

  • Deciphering Dysphagia with Estim – February 22 in Albuqerque, New Mexico  www.ampcarellc.com
  • Texas Speech and Hearing Association Annual State Convention – February 27-March 1 in Houston, TX.  (AMPCARE will have a booth, be sure to stop by!)
    • Dysphagia Research Society– March 5-8 in Nashville, TN


2014 Diagnostex scheduling paperwork – We have been handing our new paperwork in a packet on the vans, be sure to update any paperwork that you have and discard the old ones. Thank you!


Influenzea/Flu Positive results. – Any patient in isolation with the a influenza positive test or with flu/risk/symptoms of the flu should not be seen in the mobile unit.  Our small contained mobile environment can be easily exposed  and effect the fragile, elderly patients that we see during the day, despite our decontamination procedures we use.  If the patient has the flu and requires this procedure immediately, please refer to local hospital where this type of illness can be more properly handled. Thank you for your understanding and help with this issue during this flu season.


New Medicare Guidelines for SNF –  find more information at www.asha.orgEvaluation Time Does NOT Count as Minutes Toward RUG Level – When prospective payment for Part A stays in SNFs was established, the RUG rate was based on observation of time actually spent by clinicians. Time spent on evaluation was included in the calculation of the RUG rates; therefore, evaluation minutes are already accounted for and are not to be reported.  Instructions from administration or staff to limit evaluation time may be an indirect way of reminding clinicians to maximize therapy time (e.g., in an hour session, 45 minutes would be counted as therapy if the clinician did a 15 minute evaluation). If clinically appropriate, treatment can be performed on the same day as an evaluation and counted toward the therapy minutes. If the facility counts productivity using only the treatment minutes recorded in the MDS, the SLP’s productivity may appear reduced because evaluation time is not counted. Clinicians are ethically bound to deliver services that they believe are appropriate for a patient based on their independent clinical judgment. An inflexible rule governing clinical practice (e.g. “evaluations must never exceed 15 minutes”) is inappropriate. Clinicians should conduct an evaluation that provides the information necessary to make a diagnosis and develop a Plan of Care. It should be up to the discretion of the SLP as to what comprises evaluation versus treatment. Valuable information may be gathered through dynamic observation of the patient performing therapeutic activities in addition to administration of standardized or formal testing.


Rules for Recording Treatment Minutes

  • The therapist’s time spent on documentation or on initial evaluation is not included (Page O 17)
  • The therapist’s time spent on subsequent reevaluations, conducted as part of the treatment process, should be counted
  • Family education when the resident is present is counted and must be documented in the resident’s record.
  • Treatment minutes are recorded in the MDS in 1 minute increments (not 5, 10, or 15 minutes)

The minutes that define a RUG level are a minimum, not a maximum. There is no Medicare penalty if a patient exceeds the number of minutes in the RUG in a particular week. Patients who receive fewer than the required minutes will be lowered to the next RUG level.


Therapy Caps – The 2014 therapy cap for PT and SLP combined increases from $1900 to $1920 ( yes, that is $20.00).  Through the regulatory process CMS has permanently expanded the therapy cap to include critical access hospitals despite opposition from ASHA.


PQRS – All SLP’s in private practice must report on 50% of their Medicare Part B eligible patient visits in 2014 or will be penalized by 2% on ALL claims for Part B service in 2016.


New SLP evaluation codes

92521 – Evaluation of speech Fluency

92522 – Evaluation of speech sound production (e.g. apraxia, dysarthria)

92523 – Evaluation of sound production (e.g. apraxia, dysarthria,_ with evaluation of language comprehension and expression ( receptive and expressive)

9524 – Behavioral and qualitative analysis of voice and resonance.


DiagnosTEX FEE SCHEDULE – Medicare 2014 FEE schedule for 2014. – January 1- March 31st – President Obama signed into law the Pathway for SGR Reform Act of 2013, which allowed the Centers for Medicare and Medicaid Services (CMS) to release the final conversion factor for the 2014 Medicare Physician Fee Schedule (MPFS). This law prevents a sustainable growth rate (SGR) reduction of more than 20 percent that was scheduled to take effect Jan. 1. Instead, the law suspends the reduction and temporarily extends the therapy cap exceptions process through March 31. We are required by law to bill the Medicare allowable for the MBSS under Part B for the CPT code 92611, which falls under consolidated billing.  The rates below will be adjusted for the 92611 SLP MBSS CPT code and billed to your facility as indicated on the Novitas Online Fee schedule for 2014.

2013 –  CPT 92611                                2014 – CPT 92611                                           

Dallas County:              $ 88.06                         Dallas County:             $92.71

Tarrant County:             $ 86.14                         Tarrant County:             $91.05

All Other Counties:        $ 83.48                         All Other Counties:        $88.08

2014 Physician Fee Schedule – Downloads Available at Novitas – The 2014 Physician Fee Schedules have been added in several formats. You can download these files in Microsoft Excel, Adobe PDF, or in a text-delimited file at Novitas. These codes have also been loaded into Novita’s Fee Schedule Lookup Tool. Note: These files include the payment update that was signed into law with the Pathway for SGR Reform Act of 2013 on December 26, 2013 by President Obama, and are effective January 1, 2014 through March 31, 2014.