Medicare, Dysphagia, and the Medical Workup Beginning in the spring and summer of last year, at least two Medicare intermediaries (i.e., claims processing organizations) outraged some speech-language pathologists by issuing a “dysphagia medical workup form” or “dysphagia evaluation form.” Two principal objections were voiced to ASHA's health care financing division regarding these forms. The first ... Coordinator's Column
Coordinator's Column  |   August 01, 1997
Medicare, Dysphagia, and the Medical Workup
Author Affiliations & Notes
  • Mark Kander
    ASHA Medicare and Medicaid Branch
    Director
Article Information
Coordinator's Column
Coordinator's Column   |   August 01, 1997
Medicare, Dysphagia, and the Medical Workup
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), August 1997, Vol. 6, 4. doi:10.1044/sasd6.2.4
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), August 1997, Vol. 6, 4. doi:10.1044/sasd6.2.4
Beginning in the spring and summer of last year, at least two Medicare intermediaries (i.e., claims processing organizations) outraged some speech-language pathologists by issuing a “dysphagia medical workup form” or “dysphagia evaluation form.” Two principal objections were voiced to ASHA's health care financing division regarding these forms.
The first is: The forms imply that a physician must provide a hands-on examination prior to dysphagia treatment. Such a requirement can result in serious delays in the initiation of dysphagia services, especially in nursing facilities.
One reason for the distressed reaction by ASHA members is that these intermediaries, over the past years, were not fully enforcing Medicare dysphagia coverage policy as established in 1990 in the Medicare Intermediary Manual (section 3910); Medicare Skilled Nursing Facility Manual (sec.544.3); Medicare Hospital Manual (sec.450); Medicare Outpatient Physical Therapy and Comprehensive Outpatient Facility Manual (sec.504); and Medicare Home Health Manual (sec.453). The first paragraph under dysphagia coverage is headed “medical workup” and states that “patients must be selected for treatment after a proper medical diagnostic evaluation by a physician.” The special forms were initiated by the Aetna and MetraHealth intermediaries to document that this Medicare requirement—a diagnostic evaluation by a physician—was adhered to. The forms are neither actions taken by renegade intermediaries, nor do they represent a change in Medicare policy. Note also that most intermediaries will accept a modified barium swallow study as a substitute for the physician workup.
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