Question
What does it mean to “re-evaluate as needed” in terms of providing services to patients in skilled nursing facilities?
Answer
According to the rules stated in the Medicare Benefit Policy Manual, re-evaluation is covered “as needed” if there is a change in the beneficiary's condition. Re-evaluations are usually focused on the current treatment, and might not be as extensive as the initial evaluation. They are covered only if the documentation supports the need for further testing measures after the initial evaluation. Indications for re-evaluation include a new clinical finding, significant change in the patient's condition, or failure to respond to therapeutic interventions outlined in the plan of care.
Consider the following example. A patient comes in after an acute care stay and then gets a urinary tract infection, or a new respiratory infection. If your services are still indicated, and you need to go in and rework that plan of care, a re-evaluation may be indicated. If the patient has a significant decline in status, and you can still justify your services, you need to essentially rework your whole plan.
Here is an example of a scenario that clinicians sometimes thinks warrants a re-evaluation; but it actually does not. If we start in one area and need to add another area to the plan of care that does not call for a re-evaluation; rather that is a whole new evaluation. For instance, if you start with a cognitive/language plan of care, and then determine the patient also needs some voice intervention, then that is not a re-evaluation. That is a new evaluation for a new area. Remember, ASHA has worked to reestablish and redefine all of our treatment and evaluation codes. We have different evaluation codes for different areas; the voice evaluation code is different than the one for cognitive/language. If you are starting a totally new area, then that is not a re-evaluation; that is a brand new evaluation.
Re-evaluations may be appropriate prior to planned discharge for the purposes of determining whether goals have been met, or for the use of the physician or the treatment setting in which treatment will be continued. In this instance, let's say that you are in a facility that does a significant amount of rehab-to- home. As part of that assessment, speech pathology, in conjunction with OT and PT, completes the home evaluation. That may be an appropriate reason for re-evaluation -- to go in and determine the clinical needs the patient will have upon return to home, that you cannot simulate in the SNF environment.
Re-evaluations are focused on evaluation of progress towards current goals and making professional judgments about continued care, modifying goals and/or treatment, or terminating services. Re-evaluations require the same professional skills as evaluation, so you do have to show that a true hands-on assessment occurred. Re-evaluations are not routine or recurring; rather, they focus on evaluating progress toward current goals, making a professional judgment about continued care, modifying goals or treatment, or terminating services.
Renee Kinder currently serves as Clinical Specialist for Evergreen Rehabilitation where she provides education and training programs for interdisciplinary team members related to Medicare regulations, documentation requirements, and evidenced based practice patterns. She is currently Vice President of Healthcare for the Kentucky Speech Language Hearing Association, acts as an Ambassador for the Alzheimer’s Association, has provided caregiver trainings for the Alzheimer’s Foundation of America, and is a member of community faculty for the University of Kentucky College of Medicine.
