Hi Amy and Alisa,
Here is some info on your questions.
Does Medicare requires trials?
"Medicare does not require a trial.
Medicare requires consideration of other equipment to be noted in the
report, but does not require the consideration to have been by hands on
trial
Medicare does not specify that the number of alternatives to be
considered is 3 or any other specific number." L. Golinker
Denial due to current intelligibility score. Being denied at 70% intelligible with ALS if outrageous. I once
had BX deny a PALS because the intelligibility was "over 50%". It was
such an obviously random, non-informed number. I was able to get the
denial overturned by faxing documentation from the literature that states
that we determine when to persue AAC with PALS based on speech rate.
Perhaps attaching the Ball, Beaukleman, etc. articles would be
helpful. I actually always include the following paragraph in my
report if my patient's intelligibility is on the high side. So
far it has worked.
Currently, Mr. Lastname’s speech ranges from XX% intelligible to approximately XX% intelligible throughout the day. Further decline in intelligibility is expected, as ALS is a progressive degenerative disease. His speech rate is also predictive of an imminent sharp decline in intelligibility. Currently his speech rate is XX words per minute (approximately XX% of his original baseline). A slowed speech rate of approximately 100-125 words per minute in ALS patients is indicative of a precipitous decline in intelligibility usually occurring within the next two months. Research demonstrates that as speaking rate approaches 125 words per minute a patient with ALS should be evaluated for a speech generating device, even if sentence intelligibility remains over 90%. [Ball L., Willis A., Beukelman D., Pattee G. A Protocol for Identification of Early Bulbar Signs in Amyotrophic Lateral Sclerosis, Journal of Neurological Sciences 2001; 191:43-53 & Ball, L., Beukelman, D., & Patee, G. (2002) Timing of Speech Deterioration in people with ALS, Journal of Medical Speech-Language Pathology, 231-235.] There certainly are SLPs who do not include intelligibility in their
reports for PALS and this might be wise as Margaret states. I don't
think we should begin sending in recordings of our patients' speech
though. We fought a battle in CA not to have to send in videos of our
patients sucessfully using SGDs for Medi Cal funding. We don't want
to give them any ideas and end up with another hoop to jump
through.
Eye gaze approvals just seem to ramp up the standards a few
notches. If evidence based practice does not adequately satisfy
Medicare guidelines we have a real battle on our hands. See if this
is enough to satisfy.
Sincerely, Amy Roman, MS, CCC-SLP Augmentative Communication Specialist Forbes Norris ALS Research Center 2324 Sacramento Street San Francisco, CA 94115 P (415)600-1263 F (415)673-5184 CONFIDENTIAL OR PRIVILEGED: This communication contains information intended only for the use of the individuals to whom it is addressed and may contain information that is privileged, confidential or exempt from other disclosure under applicable law. If you are not the intended recipient, you are notified that any disclosure, printing, copying, distribution or use of the contents is prohibited. If you have received this in error, please notify the sender immediately by telephone or by returning it by reply email and then permanently deleting the communicationfrom your system. Thank you. --- On Tue, 5/12/09, AMY S. GOLDMAN <xxxxxx@xxxxxxxxxx> wrote: From: AMY S. GOLDMAN <xxxxxx@xxxxxxxxxx> |