February 2013 Newsletter


Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

February 2013


If you begin the day with love in your heart, peace in your nerves, and truth in your mind, you not only benefit by their presence but also bring them to others, to your family and friends, and to all those whose destiny draws across your path that day.



HIPAA Compliance Regulations – No additional audio, video recordings or photos

Please note and educate families, staff etc.  We cannot allow any form of audio recording, video recordings or photographs inside the DiagnosTEX clinic, outside of MBSS medical record, without prior approval/permission from DiagnosTEX managers or the Medical Director.


TSHA Annual Convention at the Dallas Convention Center March 7-9, 2013

DiagnosTEX will have a booth, please stop by and see us.  Pam and I will also be presenting on Saturday at 10:45-11:45 in Room 101


Dysphagia Research Society Annual Convention is March 13-16 in Seattle, Washington


SLP’s must report Medicare Outcomes in 2013

Beginning January 1, patient outcomes must be reported on claim forms.  SLP’s who provide services to Part B in all settings must report on patient progress and outcomes using G-codes. CMS will reject claims that do not include the required information. SLP’s must report on 7 measures adopted from ASHA’s NOMS.  As I have put in previous newsletters, Medicare is asking for DiagnosTEX to provide documentation on medical necessity for all repeat studies and that is why we  have been requiring some sort of documentation form the treating SLP on the history form on what progress, gains or losses the patient has had to determine the necessity of a repeat study.


Coding and Supervision in 2013

There are documentation rules unique to Medicare A in SNF’s.  Coding primarily involves recording valid treatment minutes. SNF residents can be classified as Part A for up to 100 days, as long as the skilled services are needed. After 100 days, the resident assumes Part B status and coding with CPT codes follows the Part B rules.

Students serving Part B patients in a SNF require 100% in-room supervision. SNF’s are the only facilities that have student supervision rules for Part A patients. The exception includes the supervisor and the student simultaneously treats one resident each or the student treats 2 residents simultaneously (supervisor not providing treatment).

CMS defines group treatment for Part A and B as a clinician conducting same activity with 4 residents. Concurrent treatment under Part A is limited to a clinician using different activities to treat 2 residents. Concurrent treatment is not addressed in Part B rules.  CMS requires a session to have 4 people and the session is divided by 4 (the 25% rule).


Medicare May Cover Maintenance Treatment

There is a proposed settlement of a lawsuit by the Parkinson’s Action Network. The settlement will allow Medicare beneficiaries with degenerative diseases to receive speech-language pathology and other services to maintain or prevent deterioration of function, rather than the current requirement that each patient show ongoing improvement. It may take 6 months to 1 year to finalize and implement.


Medicare cuts avoided in 2013

With just less than three hours left before the country would go over the “fiscal cliff”, the Senate unanimously passed legislation. Then at 11:00 on Tuesday night, the House voted to pass the bill that had been passed in the Senate. There is a lot of chatter that with 100 pages of legislation not all of the members in the Senate read what was contained within the document. Once again it sounds like what happened with Obama Care when Nancy Pelosi, who at the time was the Speaker of the House, said we need to pass it first and then we can go back and read it.

Nonetheless, there is a one year “Doc Fix” included in the language. As you know, we were facing a 27% cut to the MPFS for 2013. This legislation prevents the Medicare physician payment SGR cut for one year. Instead of a 27 percent Medicare physician payment cut, a “zero percent update” to the Medicare physician fee schedule conversion factor for 2013 took effect. This is a temporary extension at best, it is not a fee schedule rate freeze by any means. There are still going to be cuts to the physician fee schedule based on any conversion factor adjustments and RVU changes contained in the final fee schedule rule for 2013 may result in payment rate changes, but the massive SGR cut is nullified for a year.


TSHA stats on Speech Pathologists – Total SLP’s 15,132

3,342 Assistants

639 Interns

11,250 Fully licensed SLPs

1 Temporary Certificate


Novitas LCD L27537 – SLP services: Dysphagia: Includes Vital Stim Therapy

(Novitas is now the Medicare intermediary for Texas, it is no longer Trailblazer)

Coverage Limitations: Vital Stim Therapy will not be covered by Medicare and treatment will be deemed not reasonable and necessary in the treatment of patients with dysphagia. Their explanation states that recent studies showing lowering of the hyoid bone during swallowing, may be harmful to the patient. This and additional information can be found at https://www.novitas-solutions.com/policy/mac-ab/127537-r8.html