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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.


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