What does Medicare expect to see in a swallowing assessment?
Medicare states that swallowing assessment and rehabilitation are highly specialized services, and that the professional rendering care must have the education, experience and demonstrated competencies. This is important because if you are working in a skilled nursing facility, you know that mealtime and eating have a significant impact on quality of life. Members of the interdisciplinary team have discussions around eating and mealtime, and want to come together as a team to discuss. However, when it comes to a true swallowing assessment in rehab, Medicare is clear that the speech language pathologist is the specialist.
Competencies that should be demonstrated and documented in our evaluations include: identifying abnormal upper aero-digestive tract structure and function; conducting an oral pharyngeal, laryngeal and respiratory function examination as it relates to functional assessment of swallow; recommending methods of oral intake and risk precautions; and developing a treatment plan, employing the appropriate compensations and therapy techniques. Take a deeper look at your plans of care and your evaluations for dysphagia to ensure you are evaluating all these areas, and that they are documented clearly.
Please refer to the SpeechPathology.com course, Documenting in Skilled Nursing Facilities - Part 1, for more in-depth information on documenting plan of care requirements to support skilled speech pathology needs to Medicare beneficiaries.