Clinical Services News

Vice President for Clinical Services
Sharon Sowder, MA, CCC-SLP

Update February 2011

FEES AND MEDICAID

The two issues I am contacted about the most involve Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Medicaid issues, specifically with billing and/or becoming a provider.  I will be adding this information to my section on the website so it will be there for future reference.

The following are important websites for you should you be interested in becoming a Medicaid provider, have questions about your reimbursement, how to submit claims, etc:

For provider enrollment, provider search, provider manuals, and bulletins, or internet access try:www.dss.mo.gov/dms

For further clarification on Medicaid changes, step-by-step instructions try:
http://www.dese.mo.gov/divspeced/Finance/index.html

For information on how to submit electronic claims, verify eligibility, add provider numbers, etc., try:www.emomed.com

For enrollment for an NPI number try:https://nppes.cms.hhs.gov/NPPES/Welcome.do

To obtain HIPPA forms, codes, and software try:www.wpc-edi.com

In addition, we have access to a PERSON who is available for providing technical assistance.  Her name is Karri Thurman and she can be contacted at Karrit_2000@yahoo.com or 573 760 0154.

After doing extensive research on the questions I was receiving about FEES, I contacted Richard McGuire who is on the Missouri Board of Healing Arts Advisory Commission.  I was pleased to discover that my research has been successful in finding all the information that is available to us regarding FEES.  I thought his response was very well written and included it here for you.  Thank you, Richard, for your input and feedback.

“I offer the following opinion as an individual who has considerable knowledge of the State of Missouri Statues and Rules as well as the Scope of Practice related to Speech-Language Pathology services.  The State of Missouri Statues and Rules related to the practice of Speech-Language Pathology does not specifically define specific techniques, instruments, or methods related to service delivery.  These statutes and rules do address ethical practice and the expectation that Speech-Language Pathologists provide services within their scope of practice and personal abilities in a conscientious manner keeping the best interests of the client foremost in their considerations.  That said, Speech-Language Pathologists performing FEES (fiberoptic endoscopic evaluation of swallowing), which is within their scope of practice (http://www.asha.org/docs/html/SP2007-00283.html & http://www.asha.org/docs/html/PS2005-00112.html), must do so ethically.  That is, Speech-Language Pathologist who are considering performing FEES must possess the knowledge and skills necessary to use this technique/approach in an ethical and competent manner (I again refer you to the ASHA documents cited above).  Additionally, there may also be institutional policies/rules, outside scope of practice and licensure considerations, that may restrict or prohibit a Speech-Language Pathologist's role in this type of assessment within their organization/facility.” 

I hope this answers the membership’s questions regarding FEES and Medicaid; please feel free to contact me with further questions as they arise. 

The following areas are some of the areas addressed by the Clinical Services/Affairs section of MSHA:

• Reimbursement Issues with Medicare, Medicaid, and Private Insurance
• Minority Student Leadership Program
• Member Education
• Clarification of CPT Codes and Billing
• Licensure Issues
• Assistance with interaction with other professionals about the services we provide and our Scope of Practice
• STAR Representative to ASHA
• Consumer Advocacy
• Health Insurance Advocacy

For more information or to express interest in any of the above mentioned areas, please contact me via e-mail at VPCSmsha@gmail.com.

Documentation Examples for Cognitive Disorders

Language/Cognitive Disorder - Evaluation Summary
Evaluation of patient’s deficits indicated expressive aphasia. This disorder was characterized by anomia (naming disorder). Patient was unable to recall names of persons, places, and/or objects to communicate basic and medical needs. Patient could, however, follow simple directions and could recall the names of common objects when compensatory techniques were introduced (paring of auditory/visual stimuli) suggesting that the patient would benefit from skilled intervention. Patient also demonstrated attention deficits which made it difficult for patient to concentrate on evaluation materials. Additional training and instruction will be needed to help patient improve their ability to focus on therapeutic tasks so that language skills can improve.

Progress Notes: Language/Cognitive Deficits
Visit One: Patient seen to improve word naming skills. Patient trained in use of auditory and visual stimuli to facilitate verbal expression related to medical needs. Additional training to improve attention to therapeutic task provided (tactile cueing). Attentional training procedures helped patient focus on auditory/visual stimuli and enabled patient to recall names of body parts and medications necessary for patient’s care.

Speech/Cognitive Deficits - Evaluation Summary
Patient’s deficits were characterized by moderate dysarthria affecting ability to produce clear speech for basic and medical needs. Tongue and lip strength and range of motion were not adequate for production of understandable speech. Potential for improvement, however, is positive since patient has partial control of tongue and lip muscles and can follow directions. Additional deficits include a mild cognitive disorder characterized by short term memory problems and reasoning difficulties. Training and instruction in use of specific compensatory strategies (visual aids and reduction in use of specific compensatory strategies (visual aids and reduction in rate of word and phrase presentation) should adequately address the cognitive deficits so that the patient can benefit from training and instruction to improve speech intelligibility for the expression of basic and medical needs.

Progress Notes: Speech/Cognitive Deficits
Visit One: Patient seen to improve speech intelligibility related to medical needs. Trained to increase tongue range of motion. Visual aids introduced as necessary to compensate for short term memory disorder. Pictures presented helped patient identify target tongue positions in oral cavity. This resulted in improved pronunciation of words beginning with /l/, /t/, and/d/ sounds (leg/teeth/doctor).