Dysphagia Restrictions Reversed: Medicare Intermediary Backs Off, Other Payers May Follow Medicare fiscal intermediary has withdrawn a coverage policy that required an ordering physician to “examine and evaluate the patient’s medical condition in order to establish the need for a dysphagia evaluation” prior to an evaluation by a speech- language pathologist. ASHA’s advocacy efforts brought about this victory, which should positively ... Bottom Line
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Bottom Line  |   January 01, 2006
Dysphagia Restrictions Reversed: Medicare Intermediary Backs Off, Other Payers May Follow
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Swallowing, Dysphagia & Feeding Disorders / Practice Management / Bottom Line
Bottom Line   |   January 01, 2006
Dysphagia Restrictions Reversed: Medicare Intermediary Backs Off, Other Payers May Follow
The ASHA Leader, January 2006, Vol. 11, 3. doi:10.1044/leader.BML.11012006.3
The ASHA Leader, January 2006, Vol. 11, 3. doi:10.1044/leader.BML.11012006.3
Medicare fiscal intermediary has withdrawn a coverage policy that required an ordering physician to “examine and evaluate the patient’s medical condition in order to establish the need for a dysphagia evaluation” prior to an evaluation by a speech- language pathologist. ASHA’s advocacy efforts brought about this victory, which should positively affect several other intermediaries with the same restrictive policy.
Riverbend Government Benefits Administrator—the Medicare intermediary with primary jurisdiction in New Jersey and Tennessee—released its draft dysphagia local coverage determination (LCD) in late June for public comment. ASHA challenged the provision that required a physician to conduct a hands-on examination before ordering a dysphagia evaluation. ASHA advised Riverbend that such a policy created a safety problem because of inevitable delays in dysphagia treatment and also questioned the ability of many physicians to determine the need for a dysphagia evaluation without consultation with an SLP. In comments, ASHA cited recent revisions to the Medicare Benefit Policy Manual that deleted the requirement for physician orders before the commencement of therapies and made physician visits optional, at the discretion of the physician.
Riverbend released the final dysphagia LCD with the physician work-up requirement unchanged, effective Sept. 30, 2005. ASHA subsequently sought assistance from the Atlanta regional office and central office of the Centers for Medicare and Medicaid Services (CMS), which led to direct communication with the Riverbend medical director. Riverbend retired the LCD (also known as a local medical review policy) and agreed to omit the physician work-up from future draft policies.
ASHA will be working with CMS over the next several months to assure that this unreasonable requirement is removed from all dysphagia LCDs.
For further information, contact Mark Kander, director of health care regulatory analysis, at mkander@asha.org or 800-498-2071, ext. 4139.
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January 2006
Volume 11, Issue 1