10/23/2024
I frequently get asked by other SLPs if insurance (specifically Medicare) will cover the therapy serivces for people with neurodegenerative diseases, such as dementia, or therapy for old deficits related to a stroke. Many times, the patients are told by their doctors or other SLPs that they “won’t make any more progress,” their date of injury or stroke is “too far away,” and insurance “won’t cover any more therapy.”
I just was audited on two patients that I treated in 2022 - one patient had deficits related to an old stroke (over 1 year prior), and one had deficits related to vascular dementia. The audit found zero reasons not to cover the services. This is not intended to be a brag - this is the work we must do as providers.
Our job as skilled speech-language pathologists is to analyze what is negatively impacting this person‘s communication and functioning in their life and determine if there is anything at all we can do to make it easier or better. It can be little things, like establishing a clear baseline of cognitive-communication functioning, staging their dementia to help the client and family plan, providing counseling and teaching, or developing augmentative systems to support the client’s current communication needs, all of which are in our scope of practice.
The diligent documentation of this skill is so essential, not only for our reimbursement but for our clients and their families. Establishing a clear reason for referral, the findings of standardized tests and measures and patient-reported outcome (PRO) scores, and setting clear, meaningful goals not only follow CMS regulations but guide your therapy, provide clear evidence to our clients and their families on the status and current level of function, and promote understanding, gains, and generalization of skills.
I challenge you as professionals to consider how you represent clients on paper, use established checklists (easily found on the ASHA or CMS website), and not let the worry of insurance coverage be a barrier to giving individuals the skilled therapy they deserve.
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