November 2014 Newsletter


November 2014

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Happy Thanksgiving!

There is no better time to express our appreciation for your business and friendship! The friendship of those we serve is the foundation of our success serving the DFW area!

This is the season to reflect on your blessings and those things for which you feel most thankful.  I know at DiagnosTEX, we are incredibly thankful for each and every one of you who use us as your preferred mobile MBSS provider and have shared your friendship and support over the years. We wish you and your families and very Happy Thanksgiving with many, many blessings this holiday season!


DiagnosTEX November Holiday Schedule       Swallow and be thankful!       DiagnosTEX will be closedon Thursday, Thanksgiving Day, November 27thand Friday the 28th, to count our blessings and spend time with our families. We want to meet all of your MBSS needs because we know PO feeding becomes important on many levels to many of your patients around the holidays, especially when Thanksgiving is traditionally planned and prepared with a great deal of attention to food.  We also want to be fair and accommodating to each DiagnosTEX employee and their families. We are so thankful for them as well!  Please keep our holiday schedules in mind when scheduling your MBSS at the end of November (and December)!  ******Please take note and keep in mind that during this busy time of year, specific requests for specific times and/or days become exponentially difficult to accommodate.  We may be unable to quickly schedule your patient with certain time and day requests. Please notify your staff, patients, and families of this. ****** DiagnosTEX bases our mobile clinic schedules by geographical areas for time, efficiency and operational cost. If your patient’s schedule is limited to certain days and times, we recommend an outpatient facility (such as a hospital).  Our mobile service is an option for you that offers convenience in the equipment coming to you, not for the flexibility of specific days and time schedules.  Mobile offices also require flexibility in time; we are subject to many factors that can dramatically change our travel during the day and subsequently alter the exact time we may arrive.  We make a heartfelt effort to arrive during our scheduled time, but there are often things that are out of our control that may change our arrival time. We will always call to keep you updated on our ETA at the number you have provided us on the HX/consult form.


2014 Fall CEU Coursewith AMPCARE –  November 1, 2014 Deciphering Dysphagia with E-Stim

FDA Cleared Treatment for Dysphagia – ESP (Effective Swallowing Protocol)

Earn 8 ASHA CEU’s                  Location: TCU in Fort Worth, TX            Go to to register!


ASHA Convention– November 20-23 in Orlando, Florida  (Stop by and see the AMPCARE booth while you are there!)


Five most Common Claim Mistakes to AVOID ( from Healthcare Compliance Newsletter)

Mistake # 1 – Orders gone AWOL – orders must be part of the medical record. This includes DiagnosTEX consult form

Mistake # 2 – Illegible Records – Illegible records are as good as NO records at all.  This includes the hx consult form you send/fax to us, as this piece of paper with your information on it goes in with all audits

Mistake #3 – Medical Necessity – Medical necessity denials are clinical denials.  This is why we ask for this information on the HX/Consult form, please fill it out completely.

Mistake # 4 – Ignoring Payor’s requests – Act promptly to supply all requested information. Which is exactly what we do!

Mistake # 5 – Documentation? What Documentation? – Health records support coding, which in turn supports billing. Staff members responsible for sending patient records must recognize the documentation be complete to fulfill payer requests. (this includes Hx/Consult forms).

We often get resistance from facilities wanting to bring us a copy of the H & P (short for history and physical, the initial clinical evaluation and examination of the patient from treating physician), progress notes and/or a copy of meds to the mobile clinic if they have an electronic medical record system. Unfortunately, the convenience of having a mobile unit come to you, will be the inconvenience of printing these forms from the EMR and bringing them to the consulting physician on the mobile clinic.  This is so very important that they see this information, please provide them for us each and every time we evaluate one of your patients.  Thank you!


TSHA CE Credits and RegistryAs of Aug. 25, 2014, TSHA course sponsors will no longer be required to record CE credits for TSHA members. The system has been adjusted to allow TSHA Members to self-report continuing education credits. This only affects TSHA members, non-members will continue to receive the hard copy Verification of Continuing Education form as they have in the past.TSHA has updated the CE registry!  As a TSHA member, you will be able to self-report your credits for any TSHA approved course. Visit and click on the TSHA CE Registry option under the Continuing Education tab to access your personal registry. You have to be logged into your membership account to access your registry. A printer friendly copy of your registry is available by clicking on the overview button at the top right and then on the printer friendly button.


Cost of Hospital vs Convenience of Mobile MBSS – This is a question we get a lot from facilities who feel our Part A rate of $190 plus a $25.00 travel fee is too much for an MBSS that comes directly to the front door of the facility.  I called a local Baylor hospital to get their cost for an OP MBSS. The hospital’s cost regardless of Part A or Part B was a minimum of $1024.57. Private pay received $35% discount of that ($665).  This amount is in addition to transportation cost of the ambulance at approximately $13-$15 per mile.  The hospital confirms the facility does get the bill in full, as the patient is not resident/patient of the hospital, the patient is a resident/patient of the facility. DiagnosTEX is almost 80 % less than the hospital location. The average waiting period to schedule at a hospital was approximately 5 days to 2 weeks, unless the patient went in through the ER,


DYSPHAGIA TIDBIT  Behavioral Eating Deficits    Dysphagia and behavioral eating deficits are common in Alzheimer’s disease and other dementias (Feinberg, Ekberg et al. 1992, Horner, Alberts et al. 1994, Priefer and Robbins 1997, Wada, Nakajoh et al. 2001, Garon, Sierzant et al. 2009, Suh, Kim et al. 2009, Humbert, McLaren et al. 2010, Affoo, Foley et al. 2013), and speech-language pathologists have an opportunity to play a role in dysphagia care for these individuals at any stage. Individuals with mild dementia may experience early taste (Murphy 1999), smell (Nordin, Murphy et al. 1996), and swallowing dysfunction (Humbert, McLaren et al. 2010), which may result in decreased oral intake and weight loss.  Dysphagia is quite common in individuals with moderate dementia—the prevalence of dysphagia in moderate-to-severe Alzheimer’s disease has been estimated between 84% to 93% (Affoo, Foley et al. 2013).  Individuals with dementia often demonstrate behavioral eating deficits that limit oral intake and result in weight loss and nutritional compromise. These behaviors, while often viewed negatively, may be attempts to communicate unmet needs such as pain or discomfort (Kovach, Noonan et al. 2005). Consultation with the medical and rehab team, and with the family and caregivers may be beneficial in order to identify potential sources of pain, discomfort, fear, and confusion. Both behavioral and environmental barriers should be observed and documented, and treatment plans formulated using a problem solving approach (Smith, Kindell et al. 2009). For example, prolonged feeding and delays in the initiation of the oral stage of swallowing may significantly impact the amount of food that is consumed during a single sitting (Logemann 1998). The individual with dementia may be delaying the initiation of the oral stage due to discomfort related to oral dryness or fear and confusion at mealtimes due to feeling threatened when being fed by a caregiver. Other mealtime strategies, such as providing six or more small meals throughout the day instead of three large ones, can be implemented while assessment is ongoing. Any interaction with the client, family, and caregivers is an excellent opportunity for the SLP to provide education and counseling around the course of dementia related to eating and swallowing deficits