February 2019 Newsletter

The heart has its reasons of which reason knows nothing.

National “Wear Red” Day (first Friday in February)

Here are some interesting facts about Valentine's Day.

1. In AD 496, Pope Gelasius I declared February 14 Valentine's Day. He was a romantic!
2. In the 1800s, doctors commonly advised their heartbroken patients to eat chocolate, claiming it would soothe their pain. I don’t know about you, but Chocolate eases my pain! The Modified Barium Swallow study assesses the swallow starting with the lips and we follow that chocolate down to the stomach.
3. Richard Cadbury produced the first box of chocolates for Valentine's Day in the late 1800s. LOVE THIS MAN!
4. Teachers will receive the most Valentine's Day cards, followed by children, mothers, wives, sweethearts, and pets. 
5. About 3% of pet owners will give Valentine's Day gifts to their pets.
6. An estimated 198 million roses are produced last year just for Valentine's Day.

Texas Speech and Hearing Association Annual Convention in FORT WORTH, TEXAS

DiagnosTEX will have a booth, please stop by and see us at Booth 810!

I will be presenting with Tonya Spence, “An SLP Should Never Lose Their Voice: Advocate for Proper Dysphagia Evaluation” Thursday, February 28 at 12pm-1: 30 pm in Room 200.

Right after that, the same day, Pam and I will be presenting “What’s Your SLP Superpower? Do You Have X-ray Vision” ” on Thursday, February 28 from 2:00pm-3: 30 pm in Room 204AB.

If you can fit it in your busy TSHA schedule, we would love to see you at both!

New information for 2019

1. DiagnosTEX 2019 rate for Part A is $250 which is less than any local mobile FEES company that is currently charging $300-$350 for their bedside exam. With DiagnosTEX the staff on location includes a physician, SLP, and tech at this lower rate and a study, plus you get to see all three phases in real time.
   
   
2. With the adjustments in Medicare Part B rate, the 2019 charge for Part B is between the amounts of $88.79-$92.28 for Part B, depending on the county. This is a pass-through code, Medicare allows the facility to recoup payments for Part B through consolidated billing, and therefore the facility can bill the Speech Therapy code 92611 back to Medicare.
   
   
3. We have been informed by local hospitals that their rate for outpatient regardless of Medicare Part A, Medicare Part B or Insurance is in the ballpark of $1024.57.
   
   
4. DiagnosTEX is now a provider for most insurance companies, Aetna – pending, Amerigroup – pending, BCBS, Cigna, Healthspring, Humana, Superior, Texan Plus, Wellmed, Wellcare. We now accept a reduced rate of $350 on all NTSP insurance patients.

DiagnosTEX has a full on-site billing staff located in DFW and they are available daily for any questions or concerns. Please do not hesitate to call us at 817-514-6278 and ask for Carolyn Pitts, our billing manager or Lisa Graham, our accounts representative.

New Guidance Turns Therapy Caps into Thresholds - Under the new law, the former cap amounts ($2010 for OT and $2010 for combined ST and PT) are now threshold amounts. Claims beyond the threshold must include the KX-modifier, which confirms the patient medical records includes documentation that services are medically necessary. Claims that surpass $3000 for OT, ST and PT combined for the new patient are subject to targeted medical review.

It is encouraged that clinicians should use an Advance Beneficiary Notice of Noncoverage (ABN) to notify patients MC will not pay for their services. Members can ask for help with specific questions by contacting ASHA Health Care and Education Policy Team at reimbursement@asha.org

A Valuable Resource for Your Families and Patients with Long Term Care Insurance - Need help with long-term care Insurance claims? The experienced team at Family Solutions for Care (FSC) helps to arm you with educated information so you can make informed decisions about long-term care and your LTC insurance options. They are available to listen to you and help you understand what your policy may or may not provide.  The FSC team has been working with long-term care insurance claims and long-term care insurance claim denials since 1997.  They are the largest, consumer-based company, helping families throughout the United States with their long-term care insurance claims.  Elder law attorneys, assisted living communities, home care agencies, and other professionals in the senior-market, count on this team to help their families.  Contact them at 844-858-4500. 

Dysphagia Tidbit – Screening for Esophagus! This can only be done with an MBSS! - A growing body of research supports a more comprehensive view of dysphagia assessment which includes esophageal phase during an instrumental assessment.  This can only be done with an MBSS.

Rationale for Esophageal Screening. (Speech-Language Pathology) Screening for Esophageal Dysphagia: Enhancing the Clinical Utility of the Modified Barium Swallow, Joy Gaziano and Stephanie Watts, https://doi.org/10.1044/persp3.SIG13.67

1. Many medical conditions can have multiple swallowing impairments
1. A long established body of research illustrates the frequency of multiphase dysphagia affecting both pharyngeal and esophageal
2. Data gathered from a clinical history alone does not always differentiate oropharyngeal from the esophageal phase.
1. Only 48% of patients reporting single level dysphagia accurately localize an obstructive pathology (Ashraf, et al, 2017)
2. 1/3 of patients who complain of lower throat symptoms have an esophageal cause. (Smith, et al. 1998)
3. Thirty-five (35%) percent of patients with complaints at or above jugular notch may have simultaneous pharyngeal and esophageal abnormalities, (Jones et al, 1985)
3. Swallow Phases are interrelated
1. Ninety-two percent (92%) of those with nonobstructive oropharyngeal dysphagia had nonspecific esophageal motility disorders  (Tridafilopoulos et al, 1992)
2. In 1k consecutively referred patients with GERD, greater than 50% had pharyngoesophageal dysfunction (Henderson, 1976)
4. Oropharyngeal swallowing compensations may have a downstream effect

In this study 1 in 4 patients had an impairment in esophageal bolus flow that would have gone undetected without expanded examination.  Research support expanding the clinical utility of the MBSS with its screening of the esophagus, this can streamline health care decision making by identifying individuals at risk for esophageal dysphagia.  You cannot identify pathology of reflux with a FEES. Don’t leave out this important part of the dysphagia examine with your dysphagia patients.