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A Medicare fiscal intermediary withdrew a coverage policy that required an ordering physician to "examine and evaluate the patient's medical condition in order to establish the need for a dysphagia evaluation" prior to an evaluation by a speech-language pathologist. This victory, as a result of ASHA advocacy, should positively impact several other intermediaries with the same restrictive policy.
Riverbend Government Benefits Administrator, the Medicare intermediary with primary jurisdiction in New Jersey and Tennessee, released its draft dysphagia local coverage determination (LCD) in late June for public comment. ASHA contested the provision that required a physician to conduct a hands-on examination before ordering a dysphagia evaluation. ASHA advised Riverbend that such a policy created a safety problem because of inevitable delays in dysphagia treatment and also questioned the ability of many physicians to determine the need for a dysphagia evaluation without consultation with a speech-language pathologist. ASHA's comments also cited recent revisions to the Medicare Benefit Policy Manual that deleted the requirement for physician orders before the commencement of therapies and made physician visits optional, at the discretion of the physician.
Riverbend released the final dysphagia LCD with the physician work-up requirement unchanged, effective September 30, 2005. ASHA subsequently sought assistance from the regional office and central office of the Centers for Medicare and Medicaid Services (CMS), which led to direct communication with the Riverbend medical director. Riverbend retired the LCD (also known as a local medical review policy) and agreed to omit the physician work-up from future draft policies. ASHA will be working with CMS over the next several months to assure that this unreasonable requirement is removed from all dysphagia LCDs. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, at mkander@asha.org or 800-498-2071, ext. 4139.
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