April 2014 Newsletter
Happy Spring & Happy Easter
April 2014 Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator:
April hath put a spirit of youth in everything.
—William Shakespeare
MAY is Better Speech and Hearing Month – Be prepared! This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA has many resources to help you celebrate BHSM every day. www.asha.org . Some good educational material to share can also be found in the booklet ABOVE and BEYOND.
ABOVE and BEYOND By: Ronda Polansky M.S. CCC-SLP – Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation. Over 30 handouts on specific disorders in dysphagia in ONE location to use in your practice, plus a resource section for SLP’s on cranial nerve testing, pharyngeal exercises, and treatment techniques. A need to have booklet in your therapy bag!! Cost: $40.00. (plus S&H). Call us and we will get one out to you!
2014 DiagnosTEX scheduling paperwork – We have been distributing 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!
Upcoming Continuing Education
– ASHA Health Care and Business Institute – April 11-13 in Las Vegas, Nevada
– AMPCARE ESP – Deciphering Dysphagia with E-Stim www.ampcarellc.com
- San Antonio, TX- April 5, 2014
- Dallas, TX- April 12, 2014 (Pending Confirmation for Location)
- Columbus, OH- April 26, 2014
Call for participants for a new research study.
Are you a Parkinson disease patient with voice and/or swallowing problems or know someone who is? There is a research study to look into these issues. This study is conducted by Dr. June Levitt, an assistant professor at the Texas Woman’s University (TWU) in collaboration with Ronda and Pam/DiagnosTEX. It is titled: “The Effect of SPEAK OUT!® and LOUD Crowd® Voice Therapy programs for Parkinson’s Disease on swallowing behaviors.” The main purpose of this study is to see if the trained vocal folds with the SPEAK OUT!® and LOUD Crowd® Voice Therapy programs can protect air way better for swallowing. We share the muscles for speaking and swallowing. The researchers would like to see if the trained muscles in the throat for talking would improve the swallowing safety. You can decide to participate in the voice therapy or not. If you participate in this study either way, you will see the researchers four times over 12 weeks. Researchers will record your voice and check your swallowing behaviors each time you see them. The study is approved by TWU’s Institutional Review Board (IRB). All information gathered in this study will be kept confidential in accordance with the research guidelines of the University. If you are interested in participating in this study, please contact: Parkinson Voice Project at (469) 375-6500 or Dr. June Levitt at 940-898-2033.
Food Allergies – The DiagnosTEX hx/consult form, has a blank for this information. It is certainly information we like to have, to avoid giving any food a patient may be allergic to, but DiagnosTEX will not be providing any specialized food for the exam. Therefore, if there are limitations such as gluten free, nondairy, fruit allergies etc., please provide any specialty food items in testable consistencies (i,e, crackers) otherwise the study may be limited to the barium liquid and paste.
Transition of Medicare Therapy Review Contractors –The Centers for Medicare & Medicaid Services (CMS) announced transition dates for Recovery Audit Contractors (RACs) due to the issuance of new contracts. The transition dates affect the manual medical review process for therapy claims, though it is unclear if or when providers will see changes in the additional documentation requests (ADRs) for therapy services provided over $3,700. Changes SLPs can expect in the new RAC contracts include the following.
- RACs must wait 30 days to allow a discussion period prior to sending the claim to the MAC for adjustment.
- RACs must confirm receipt of the discussion request within 3 days.
- RAC will not get paid their contingency fee until the second level of appeal is finalized.
- ADR limits will be revised to consider claim types (inpatient and outpatient).
- ADR limits will be adjusted according to provider compliance (this is not directly related to the manual medical review, which requires every claim over $3,700 to undergo the review process).
SLPs should watch for updates and notices from their regional RACs and MACs for information regarding transition dates and process changes.
Repeat Studies – Medicare is red-flagging multiple studies/repeat studies and denying payment without clear documentation of medical necessity. They will not pay for REPEAT studies for reasons that include such things as the following:
1) Family request (please do not write this statement on your documentation anywhere, including hx /consult form. This is in no way a definition of medical necessity in Medicare’s book)
2) Pt has already signed a waiver/AMA and is on a diet ( Medicare will not cover the reason, of “just want to see if they are doing better”, because if they are not, they are going to continue to eat)
3) Recent MBSS with NPO recommendations, but now not a candidate for a PEG (this does not change results)
4) More than 3 studies in a 6 month period, with same recommendations and no progress
5) Repeat study when patient is receiving no ST therapy, unless patient has had a dramatic decline since discharge from therapy.
There must be clear documented change in therapy goals (improvement), medical status (improvement or decline), and /or a new onset of a dysphagia related diagnosis. If none of these apply the facility or family/pt must sign a form to accept responsibility for payment for MBSS. Medicare will not pay even with a “physician’s order” if medical necessity is not clearly identified and documented.
*****New Healthcare Era – Scheduling studies***********
We have had many calls lately, as facilities are not getting their swallow studies scheduled as quickly as they would prefer. Due to a new healthcare era that has resulted in reimbursement cuts of at least 30%, in turn resulting in budget changes for us. DiagnosTEX has had to make some organizational decisions to remain profitable and stable in a volatile healthcare environment. When we started 10 years ago, reimbursement was significantly different, government was different, and healthcare provided to those who needed it was different………………. we operated differently. The mobile operation remains an avenue that has not been recognized as its own entity by Medicare. We are considered no different than a free standing facility, therefore our cost of maintenance on vehicles, fuel etc. are not considered in the reimbursement for an MBSS. Although our reimbursement has decreased annually, we have continued to provide this service at a lower cost to the facilities, much lower than transporting the patient out to the hospital. We continue to petition Medicare about these issues today, but it is a slow process and will not happen overnight, like most governmental issues.
Saying all this, we need our customers to recognize, that although the service is still needed and still requested, our ability to get out to you in 24- 48 hours is no longer as easy as it used to be. Not to say that we won’t get to your patients that quickly, but there is a high possibility once a study is sent in there may be a period of 1 week before it is scheduled. If the situation requires immediate attention, you may need to consider a hospital. Effective this year, we have reduced the number of our mobile clinics on the road in a day, as our vans can only operate to maximum efficiency if we schedule several studies geographically in a more condensed area.
As always we have a very difficult time meeting the needs of those who require a specific time, day and/or specific date, as we are unable to schedule in that manner being a mobile company. Such scheduling requires a free standing facility. Mobile is for the convenience of us coming to you and not having to schedule outside the facility or home that would require transportation to that location. We ask for your flexibility and understanding regarding scheduling that may exceed a 2-3 day wait, in this new era of healthcare. We will continue to provide the same quality as you have always expected from us.
DiagnosTEX Electronic Medical Record (EMR) – As most of you in the healthcare field know, an EMR is now required in the healthcare setting. DiagnosTEX implemented our new EMR last month. The physician report will look slightly different but contain all of the same information, As we adjust to this new system and form of documentation, the reports may take a little longer than usual, effecting our schedule some. We will succeed at becoming more efficient the more we use it, but there will be a training period, a learning period, and efficiency period with this change in system. The SLP report will remain the same format.
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