Question
Does Medicare require that evaluations be medically necessary?
Answer
You should only evaluate if you believe that the patient has a need. When I approach evaluation and treatment, I usually screen everyone who comes in. I find that my nurses are not the best referral sources because they may not see something in the chart that I do. I usually review all of the charts of our patients who are coming in for a SNF stay. Essentially, I am screening everyone. I do an evaluation if I see things in the chart that make me wonder if the patient has had a decline or if the patient has the right supervision or assistance set up at home. Maybe I need to help identify what deficits are present so when the patient returns home, everything will be in place. A good example is a person who has fallen and has a hip fracture. They may not need extensive cognitive rehabilitation, but I might do an evaluation and brief treatment to help the physical therapist and occupational therapist understand what is appropriate in terms of communication and their ability to learn. An evaluation should be medically necessary based on your review of the chart and based on your screening. You should not evaluate everyone. That is a complaint that I have heard a lot -- that therapists are being required to evaluate everyone. I think that is unnecessary.
Rachel Wynn, MS, CCC-SLP is the owner of Gray Matter Therapy, a website dedicated to providing information about ethics in the SNF setting, functional treatment ideas, and recent research related to cognitive-communication disorders, including dementia.
