Medicare Documentation Requirements for Dysphagia Service Delivery The information discussed in this article is based on the following Medicare policy sections: Special Instructions for Medical Review of Dysphagia Claims (Medicare Program Integrity Manual, Chapter 6, Section 10) and Medical Review Part B, Outpatient Speech-Language Pathology Bills (Medicare Program Integrity Manual, Chapter 6, Section 6). The documentation ... Article
Article  |   March 01, 2004
Medicare Documentation Requirements for Dysphagia Service Delivery
Author Affiliations & Notes
  • Thomas J. Slominski
    Northern Speech Services, Gaylord, MI
Article Information
Swallowing, Dysphagia & Feeding Disorders / Practice Management / Articles
Article   |   March 01, 2004
Medicare Documentation Requirements for Dysphagia Service Delivery
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), March 2004, Vol. 13, 3-7. doi:10.1044/sasd13.1.3
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), March 2004, Vol. 13, 3-7. doi:10.1044/sasd13.1.3
The information discussed in this article is based on the following Medicare policy sections: Special Instructions for Medical Review of Dysphagia Claims (Medicare Program Integrity Manual, Chapter 6, Section 10) and Medical Review Part B, Outpatient Speech-Language Pathology Bills (Medicare Program Integrity Manual, Chapter 6, Section 6). The documentation requirements found in the above Medicare publications will be summarized and will include the Medical Work-Up, Necessity of Service, Expectation of Improvement, Need for Skilled Service, Functional Goals, Progress Statements and Need for Continuing Treatment.
Effective June, 2003, the Medicare program deleted the medical review guidelines referenced above so that each local Medicare intermediary or carrier could develop their own guidelines (intermediaries process claims from health care facililities while carriers process claims from physician offices). To determine if your intermediary or carrier has developed a Local Medical Review Policy, also known as a Local Coverage Determination, go to cms.hhs.gov/mcd/search.asp and check “Local Coverage; LMRP/LCD;” and enter Keyword: “Speech-language,” or “Dysphagia.” If a LMRP/LCD is not in effect, or it does not address certain issues, the former national medical review guidelines should be referenced. The national guidelines are found at asha.org/members/issues/reimbursement/medicare_dysphagia.htm
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