June 2012 Newsletter


June 2012

Summer is here!

Happy Father’s Day!


Do not forget to fly your American flag on the 14th in honor of our country, our troops and our freedom!

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP


It was so good to see everyone at the May CEU course.  Thank you to all who attended. Enjoyed spending Friday with you!


June handout on Multiple Sclerosis

Be sure to get yours next time we come to see you!


DiagnosTEX seeing outpatients in Hurst on Fridays! 

We have had several people interested and are now taking advantage of scheduling outpatients or home health patients for an MBSS on Fridays at our office inHurst.  Appointment times are more flexible at the office.  The same paperwork is required to get scheduled.  We accept both adults and children (7 yrs and older) at this location and you are likely to get scheduled quicker with us than a hospital location.


Co-Billing with Dysphagia

SLPs can bill for cognitive treatment (97532) and dysphagia treatment (92526) on the same day, with the use of the -59 modifier. CMS maintains that the codes may be billed together only for patients who have 2 distinct plans of care for dysphagia and cognition impairments indicating it would be most efficient to treat both disorders on the same day. You can find more information on NCCI edits at the ASHA website.


Medicare Audits for Anti-Fraud Efforts

New fraud-fighting efforts have been initiated by the US Department of Justice (DOJ) and Department of Health and Human Services (HHS) through the Health Care Fraud Prevention and Enforcement Action Team (HEAT).  The Affordable Care Act has provided HEAT with an additional $350 million for the next 10 years. In partnership with HEAT, Medicare has expanded the Fraud Strike Force Operation to include nine fraud hot spots:Baton Rouge, Brooklyn,Dallas,Detroit,Houston,Los Angeles,Miami, andTampa.  HEAT claims data is available simultaneously to all investigators and allows for real-time analysis of claims.  In 2011, $735 million was recovered as a result of whistleblower complaints, which is a 50% increase under the new Senior Medicare Patrol.


Repeat Studies

If you need a repeat MBSS on your patient, please be sure to expand on your reasoning for the repeat study on your paperwork. For example: change in status (good or bad) and/or improvement after treatment. We must have this type of information for reimbursement purposes on repeat studies. Also another area of concern is performing repeat studies on patients who have already signed an AMA for their preferred diet. We are required to document why a repeat study is necessary if they are not going to follow the recommendations provided.  Medicare does not view this as “medical necessity” and are reviewing these cases very closely, all the way back to initiation of treatment. Starting this year, they are also reviewing cases where the admitting diagnosis is orthopedic and/or surgical.  If there is a dysphagia, the paperwork work must indicate that the dysphagia is unrelated to aftercare of surgery.  MBSS will not be covered for orthopedics and must be related to additional diagnosis.

Healthcare is getting more complicated and we will all be required to defend our jobs and recommendations in all areas.


New Evaluation and New Patients If you have a new admit from another facility or are now seeing them in HH and you think they might need an MBSS, please do not hesitate to call us and ask if one has been done.  We can send you the latest report that you most likely did not receive in the transfer.  We all need to work together on providing the best services for these patients!


Dysphagia Tidbit – Oral Hold and How It Can Affect Viscosity

A research study completed in Dysphagia (2012) 27:10-19 describes the effect of saliva on the viscosity of thickened liquids.  Thickeners are composed of primarily modified starch and some varieties of powdered gums. Amylase is a digestive enzyme found in saliva (see latest DiagnosTEX handout on saliva J), that initiates breakdown of starch. Two thickeners were studied; one comprising of modified maize starch and one that included additional gums.  They were added to drinks with neutral and acidic pH (water and orange juice).  Two clinical scenarios were simulated:  1) effect of saliva on fluid as it is swallowed, 2) effect of when saliva enters a cup and contaminates a drink.  Saliva was found to reduce the viscosity of water thickened with maize starch in both scenarios 1) 90% reduction after 10 sec and 2) 100% reduction in viscosity after 20 minutes. The thickener composed of gums and maize starch showed a significant reduction but maintained a level of thickening. In contrast, the orange juice (pH 3.8) did not undergo any measureable reduction in viscosity under the action of saliva.

The Effect of Saliva on the Viscosity of Thickened Drinks  Ben Henson, Mark T. O’Leary, Christina H. Smith


DiagnosTEX website – The Clinical Café is a reference source for you.  All previous handouts and newsletters can be found there.  You can type a topic into the search section and it will locate all newsletters and handouts containing that key word. All upcoming conferences will also be listed on the calendar. www.dysphagiadiagnostex.com


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