SpeechPathology.com Phone: 800-242-5183


CaptionCall Mobile App - January 2020

What are Skilled Services?

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

July 14, 2014

Share:

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
Presented by Nancy B. Swigert, MA, CCC-SLP, BCS-S
Video

Presenter

Nancy B. Swigert, MA, CCC-SLP, BCS-S
Course: #9007Level: Intermediate2 Hours
  'explanations of more models supervision'   Read Reviews
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.

Anatomy & Physiology of the Upper Aerodigestive Tract: Breathing and Swallowing in Adults
Presented by Nancy B. Swigert, MA, CCC-SLP, BCS-S
Video

Presenter

Nancy B. Swigert, MA, CCC-SLP, BCS-S
Course: #9621Level: Advanced2 Hours
  'Practical examples'   Read Reviews
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.

Building Your Case for Medical Necessity: The Nuts and Bolts of Skilled Therapy Documentation
Presented by Melissa Collier, MS, CCC-SLP, CHC, CDP
Video

Presenter

Melissa Collier, MS, CCC-SLP, CHC, CDP
Course: #9839Level: Introductory1.5 Hour
  'The presenter is very thorough with her knowledge base of documentation requirements!This presenter was extremely organized, matter-of-fact, and provided excellent slides throughout the entire presentation'   Read Reviews
This course provides participants with an understanding of documentation requirements in a post-acute setting, including Medicare regulations and guidelines. It identifies why speech therapy services are denied and ways to mitigate the denial of skilled services, and describes how to document medical necessity.

Unique Coding, Billing, Reimbursement, and Supervision Issues for SLP Voice Specialists
Presented by Dee Adams Nikjeh, PhD, CCC-SLP
Video

Presenter

Dee Adams Nikjeh, PhD, CCC-SLP
Course: #8305Level: Intermediate1 Hour
  'Well organized and the speaker had a good understanding of the presented material'   Read Reviews
This course will target unique coding, billing and supervision issues specific to speech-language pathologists who provide behavioral and qualitative analysis of voice, instrumental laryngeal assessments, and therapeutic intervention of voice and upper airway disorders. Optimal professional practice requires applicable knowledge of supervision regulations, billing options, and current health care coding systems (i.e., CPT and ICD).

Taking the 'OMG' out of AAC Report Writing
Presented by Kim Winter, MA, CCC-SLP
Video

Presenter

Kim Winter, MA, CCC-SLP
Course: #8307Level: Introductory1.5 Hour
  'The presenter was very knowledgeable about all aspects of obtaining AAC devices for students or patients'   Read Reviews
This course will discuss information (e.g., AAC types, features, access methods, evaluation elements) that is necessary to accurately document augmentative/alternative communication (AAC) assessment outcomes for funding of a device via Medicare, which is the largest funding source of speech generating devices (SGDs). However, the content of this course is also applicable for SLPs working with clients who need AAC funding from any third-party payer source.