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What are Skilled Services?

Nancy B. Swigert, M.A., CCC-SLP, BCS-S

July 14, 2014

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Question

What are some examples of skilled services?

Answer

There is a difference between skilled services and unskilled services. For skilled care, or professional work, Medicare and most other payers say it has to be medically necessary which can be tough to explain since we also provide what we would consider educational services.  Skilled services are services that are at a level of complexity and sophistication that only you, as an SLP, can do.  If you find that what you do in a session is practicing, that is not skilled care.  You should be using your skill and judgment to challenge the patient, to help them reduce their reliance on cues and to make the activity more difficult.  If you are only practicing, that is something that could be done by a caretaker.

Skilled services include:

  • Analyzing medical behavioral data and selecting appropriate evaluation tools and protocols
  • Developing and delivering treatment activities that follow a hierarchy of complexity to get the target skills to a functional goal
  • Modifying activities during the treatment session based on expert observation
  • Explaining the rationale and expected results to the patient and caregives, and giving reinforcement
  • Conducting an ongoing assessment of patient response
  • Training and providing feedback in the use of compensatory skills and strategies
  • Developing, programing and modifying augmentative and alternative communication systems
  • Instructing the patient in how to use and care for the communication system
  • Developing maintenance programs for the patient and the caregiver to carry out; in order for them to optimize the trained skills and to generalize those skills
  • Evaluating the patient's current functional performance to prevent deterioration

​Nancy B. Swigert is the director of Speech-Language Pathology and Respiratory Care at Baptist Health Lexington at their acute care facility in Lexington, KY.  She is a Board Certified Specialist in swallowing and swallowing disorders.  She is an adjunct faculty member at the University of Kentucky and Nova Southeastern University. She has authored six publications with Linguisystems and she lectures extensively in the areas of dysphagia, coding and reimbursement.


nancy b swigert

Nancy B. Swigert, M.A., CCC-SLP, BCS-S

Nancy B. Swigert is the director of Speech-Language Pathology and Respiratory Care at Baptist Health Lexington at their acute care facility in Lexington, KY.  She is a Board Certified Specialist in swallowing and swallowing disorders.  She is an adjunct faculty member at the University of Kentucky and Nova Southeastern University. She has authored six publications with Linguisystems and she lectures extensively in the areas of dysphagia, coding and reimbursement.

She received her master’s degree from the University of Tennessee-Knoxville.   She currently chairs the American Board of Swallowing and Swallowing Disorders.


Related Courses

Assess and Improve Your Supervision Skills
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Course: #9007Level: Intermediate2 Hours
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SLPs should assess a variety of skills needed for effective supervision, including: building relationships, communicating, goal-setting, assessing performance, providing feedback and guiding changes in behavior, and managing conflict. In this course, strategies to improve supervisory skills in each area are shared, and web-based tools to increase efficiency are highlighted.

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Course: #9621Level: Advanced2 Hours
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Effective management of dysphagia in adults requires thorough knowledge of the anatomy and neurophysiology of swallowing and respiration and the coordination of these functions. Shared structures and neurophysiology of the aerodigestive tract are discussed as well as diseases of the respiratory system that can impact swallowing. Examples of application of this information to the evaluation and treatment of dysphagia are provided.

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Course: #10448Level: Intermediate1.5 Hours
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This is Part 1 of a two-part series. Evaluation of feeding/swallowing in children age 0-3 is discussed, including: careful history-taking to allow comparison to age-typical anatomy, physiology and oral sensorimotor skills; assessment of overall body systems and skills with age-appropriate foods/liquids; and using assessment results to identify compensations and facilitations that support optimal function.

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This is Part 2 of a two-part series. Use of a total oral sensorimotor approach to treatment planning for feeding/swallowing disorders in children age 0-3 is discussed. Long-term and short-term goals and therapy objectives that are measurable, understood by payors, and that address rehabilitative, facilitative and compensatory strategies as well as caregiver engagement are described.

Treating in the Gray Zone: Post-Acute Care Considerations
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This course helps post-acute care clinicians better understand how to approach treatment when things aren’t black and white. It addresses scenarios such as geriatric frailty/weight loss and diet modification, the paradigm shift to a patient-choice model, legal considerations regarding diet waivers, and the care plan process. The SLP's role on the post-acute interdisciplinary team is also discussed.

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