Medicare Fee Schedule: What, Why, How

Steve White

doi:10.1044/leader.bml.16012011.3

2008 Update on the Medicare Exceptions Process

Perspectives on Administration and Supervision ◽

10.1044/aas18.1.10 ◽

2008 ◽

Vol 18 (1) ◽

pp. 10-16

Author(s):

Robert C. Fifer

Keyword(s):

Close Attention ◽

Submission Process ◽

Final Rule ◽

Fee Schedule

Abstract Since 1999 when Medicare caps first became effective, providers have had to pay close attention to the claims process. This article summarizes the Medicare Exceptions Process that, for 2007, underwent a number of changes. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Final Rule of November 27, 2007 made three important changes. These changes addressed certification for patient plan of care, personnel qualifications for therapists, and a review of Part B policies and their application to Part A settings that are projected to go into effect in July of 2008. Particular attention was given to explanations of the manual submission process and the change in definitions of “complexities” and of a “therapist.”

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Business: Making Cents of Coding Systems: Billing for Professional Services

Perspectives on Administration and Supervision ◽

10.1044/aas20.1.3 ◽

2010 ◽

Vol 20 (1) ◽

pp. 3-8

Author(s):

Dee Adams Nikjeh

Keyword(s):

Professional Services ◽

Speech Language Pathology ◽

Coding Systems ◽

Language Pathology ◽

Program Funding ◽

Fee Schedule ◽

Procedure Codes ◽

Relationship Of ◽

The Impact ◽

The Relationship

Abstract Administrators and supervisors face daily challenges over issues such as program funding, service fees, correct coding procedures, and the ever-changing healthcare regulations. Receiving equitable reimbursement for speech-language pathology and audiology services necessitates an understanding of federal coding and reimbursement systems. This tutorial provides information pertaining to two major healthcare coding systems and explains the relationship of these systems to clinical documentation, the Medicare Physician Fee Schedule and equitable reimbursement. An explanation of coding edits and coding modifiers is provided for use in those occasional atypical situations when the standard use of procedural coding may not be appropriate. Also included in this tutorial is a brief discussion of the impact that the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331 Medicare Improvements for Patients and Providers Act [MIPPA], 2008) has had on the valuation of speech-language pathology procedure codes.

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