October 2013 newsletter


October 2013

                        Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator:

Everyone enjoys doing the kind of work for which he is best suited. Far and away the best prize that life has to offer is the chance to work hard at work worth doing.




FLU season – We ask that if you or a family member or even the patient is ill with an active cough, sneezing, and/or fever that you do not attend the MBSS on the mobile clinic or reschedule the patient, as we do not want to contaminate our small area. We see many fragile individuals in a day in this small environment and also our staff is small and their absence is greatly felt if they become ill.  Please be considerate during this flu season and refrain from being on the van if you or a family member does not feel well. If the patient is ill, please reschedule for another day.  Thank you!


Alzheimer’s facts

  • 5.4 million Americans are living with Alzheimer’s disease.
  • One in eight older Americans has Alzheimer’s disease.
  • Alzheimer’s disease is the sixth-leading cause of death in the United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.
  • More than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer’s and other dementias.
  • Payments for care are estimated to be $200 billion in the United States in 2012

The Alzheimer’s Association Walk to End Alzheimer’s™ is the nation’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Held annually in more than 600 communities nationwide, this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Take the first step to a world without Alzheimer’s by finding a Walk near you. Once you register, you will have access to a wide range of tools and support through your Participant Center, ensuring a successful and fulfilling experience. When you participate in Walk, your fundraising dollars fuel thier mission-related initiatives of care, support and research. In addition, your actions, both through fundraising and participating in the event, help to change the level of Alzheimer’s awareness in your community


MBS Studies Under Home Health PPS  – We get many questions on this. ASHA sought clarification from the Centers for Medicare and Medicaid Services(CMS) regarding the financial liability of a home health agency when a Medicare patient requires a modified barium swallow (MBS) study.  We were informed that the outpatient or hospital may bill Medicare directly for the radiology portion of the test (CPT 74230).  This procedure code pays for the radiology technician and an interpretation by the radiologist.  The Medicare Part B fee (subject to geographic adjustments) is $78.78 [2004].  The hospital charges a negotiated rate to the home health agency for the MBS services of the hospital speech-language pathologist. Those SLP MBS services are CPT code 92611, valued at $83.48-$88.06 depending on county, in the Part B fee schedule. The home health agency must pay for the services of the hospital/outpatient speech-language pathologist with funds that were paid by Medicare to cover the patient’s 60-day episode under the prospective payment system (PPS).  PPS covers the core home health services:SLP, OT, PT, Social Work, HH Aide, and Nursing. CMS states that the speech-language pathologist costs associated with dysphagia evaluation (CPT 92610) and the MBSS (CPT 92611) for home health patients were included in home health cost reports for purposes of calculating the PPS payment rates. Please share this information with your HH agencies.  Any further questions can be directed to ASHA Contact: Mark Kander.


TSHA?  ASHA? CEU Hours – I get many calls on this every year, so I hope this information helps clear up some confusion


  • The State Board requires 20 hours of CEU to renew a 2 year license. You are required to have 2 hours of ethics CEU credits and take the jurisprudence exam  to renew your  state license every  2 years.
  • ASHA requires 30 hours every 3 years to maintain CCC
  • ACE is awarded to those SLP’s who earn 7.0 CEU’s (70 hours) within 3 years
  • TSHA does not require CEU hours to maintain membership. ANY conference that has TSHA CEU hours WILL go towards credit for CE hours for BOTH your license as well as ASHA CCC.


What you need to know  – CMS – The American Taxpayers Relief Act of 2012 revised payment liability for therapy limit denials.  The law CHANGES denials from beneficiary liability to provider liability in 2013.


MBSS Repeat Studies in 2014 – It is absolutely necessary to have medical necessity documented on the consult form with an order to repeat a MBSS in this new healthcare era.  Medicare is red flagging multiple studies and denying payment without clear documentation of medical necessity.  They will not pay for REPEAT STUDIES on reasons that include such things as the following: 1) Family request, 2) Signed AMA/waiver, want to see if they are safe now, 3) recent MBSS with NPO recs but now not candidate for PEG. 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 of MBSS.   If those reasons do apply please clearly document this on the paperwork you send in to schedule. Medicare will not pay even with a “physician order” if medical necessity is not clearly identified and documented.


Texas Bill 945 – On May 18, 2013 The Governor of Texas approved Senate Bill 945 which amends the Health Safety Code with a provision related to truth in advertising, which requires health care providers providing direct patient care to wear photo identification during all patient encounters. This act takes effect January 1, 2014.


CEU opportunity this monthMedical Speech Language Pathology and Adults with Complex Conditions: Influence of Underlying Diseases in the Management of Dysphagia. Saturday October 19, 2013. Baylor Heart and Vascular Hospital, Dallas, TX. Presented by James L Coyle PhD., CCC-SLP, BRS-S. For more information contact 214-820-3543.


Dysphagia Tidbit – NY Times article – In Nursing Homes, an Epidemic of Poor Dental Hygiene. August 4, 2013, By: Catherine Saint Louis. “The lack of daily oral care in nursing facilities is “an epidemic that almost universally overlooked”, said Dr. Sarah Dirks, a dentist who treats nursing home residents in San Antonio, TX.  The neglect to the oral cavity can lead to terrible pain and other problems for residents.  New studies suggest that this problem may be contributing to pneumonia, a leading killer of institutionalized older people. A 2006 study of five facilities in upstate NY found only 16% of resident’s received oral care at all.  Among those who did, an average tooth brushing was about 16 seconds.  Nearly two-thirds of those who stay in a nursing home long tern have dementia and many of them resist oral care. The NIH is financing research to address such resistance among NH residents with dementia.  Since 2004, researchers first linked oral bacteria to the occurrence of hospital – acquired pneumonia in older people, a series of studies has shown that oral care, from regular brushing to professional dental care, might reduce this risk. Medicare does not cover dental care, most states provide at least some dental services to adults on Medicaid, but coverage varies widely.

Oral care is a significant part of dysphagia management as well.  Without good oral care the oral phase can breakdown in many ways: decreased ROM, loss of teeth, ulcers, thrush, mucous build up etc.  Pristine oral care prior to implementing such protocols such as Frazier free water is absolutely necessary and those who are NPO can also aspirate on their own secretions filled with oral bacteria.  Oral care and brushing should be a part of a dysphagia management protocol with residents, so we as a profession can assist in relaying how important this daily routine, that most take for granted, is to our patients.