Skip to main content

Medicare Basics: Payment Systems and Settings, SLP Coding, Claim Submission, and Clinical Supervision Compliance

Medicare Basics: Payment Systems and Settings, SLP Coding, Claim Submission, and Clinical Supervision Compliance

Tuesday, December 7
5:00 P.M. - 7:00 P.M. ET

Basic information for speech language pathologists concerning Medicare payment systems, practice settings, clinical supervision policies, and documentation requirements will be presented. Essential information for accurate Medicare claims submission will be covered such as the Medicare Physician Fee Schedule, CPT and ICD-10 health care code sets, and CMS approved code modifiers and edits. In addition, Federal government definitions for abuse and fraud will be covered and illustrated as they relate to services provided by speech-language pathologists. Questions are encouraged; resources are provided.

Learning Objectives
  • Describe payment systems related to Medicare Parts A and B. 
  • Articulate clinical supervision requirements for intervention provided to Medicare beneficiaries under Parts A and B as defined by the Centers for Medicare and Medicaid Services (CMS).
  •  Apply CMS-approved coding edits and modifiers on outpatient Medicare claims. 
  • Recognize two noncompliant billing behaviors for Medicare outpatient services that may be considered violations of the False Claims Act.
Time-Ordered Agenda
5:00 P.M. - 5:03 P.M. ET  Intro
5:03 P.M. - 5:28 P.M. ET   Medicare ABCs
  • Payment systems and practice settings
  • Medicare Administrative Contractors (MACs)
  • Local Coverage Determination (LCD)
  • Application Scenario
5:28 P.M. - 5:58 P.M. ET  Claims Submission and Payment – Essential Info
  • CPT and ICD-10 code sets
  • Medicare Physician Fee Schedule
  • Edits and Modifiers (NCCI edits, MUE)
  • Therapy threshold – KX modifier
  • Application Scenarios
5:58 P.M. - 6:03 P.M. ET  Q&A
6:03 P.M. - 6:18 P.M. ET   Medicare Documentation
  • Skilled intervention
  • Maintenance intervention
  • Reevaluation
6:18 P.M. - 6:28 P.M. ET  Medicare Supervision Requirements
  • Application Scenario
6:28 P.M. - 6:43 P.M. ET   Abuse and Fraud
  • Medicare definitions
  • SLP examples
6:43 P.M. - 6:45 P.M. ET  Audit and Appeal Resources
6:45 P.M. - 6:55 P.M. ET  Q&A 
6:55 P.M. - 7:00 P.M. ET  Closing

Webinar Cost
CAPCSD Member $50.00
CAPCSD Affiliate Member $75.00
CAPCSD Non-Member $75.00

Dee Adams Nikjeh, PhD, CCC-SLP, ASHA Fellow

Dee Adams Nikjeh is an expert in health care code sets, compliance requirements, and billing practices for the field of speech-language pathology (SLP). She co-chairs ASHA's Health Care Economics Committee and is the SLP advisor on the American Medical Association's Relative Value Update Committee/Health Care Professionals Advisory Committee. Dr. Nikjeh's professional career in the field of communication sciences and disorders spans four decades as a clinician, researcher, educator, expert witness for the US Department of Justice Civil Division, coding and claims consultant, and an advocate for the profession. She has served on ASHA's Legislative Council and the Executive Board of the Council of State Association Presidents and is a past-president of the Florida Association of Speech Language Pathologists and Audiologists.

Financial: Dee is receiving an honorarium for presenting this webinar. 
Non-Financial: Co-chair ASHA Healthcare Economics Committee SLP Advisor and member of American Medical Association’s Relative Value Update Committee Healthcare Professional Advisory Committee Review Board