Funding for Standing Frames
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This presentation goes over the basic steps on how to get a standing frame/stander covered by public or private insurance. Topics include the process to obtaining a standing frame, team players (PT, OT, DME Supplier, consumer/family) and their roles, how to write a successful letter of medical necessity/justification, research studies on the benefits of standing, and how to appeal a denial for a stander and use resources such as PAAT and AT projects.
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Funding for Standing Frames
- 1. Funding and Documentation for Standing Frames By Nancy Perlich COTA, ATP
- 8. Team Players
- 14. Letter of Medical Necessity (LMN) & Other Documentation
- 26. Research
- 31. Denied? What now? Appeal!
- 35. PAAT Who they are and how they can help
- 37. AT Project Who they are and how they can help
- 40. Questions? Contact me [email_address] or call toll free at 877.844.1172 www.easystand.com
Editor's Notes
- Here is a quick overview of topics I’d like to cover today.
- It’s imperative to understand the basic acquisition process for CRT. Here are the basic steps we suggest to the consumer on our website. You’d be surprised how many new clinicians don’t know this process.
- A trial of the stander is always important. For insurance Payers and self pay. You want to make sure the device works for you!
- I will be going over LMN details further in the presentation.
- QUESTIONS?
- Roles and Responsibilities of team members
- If the physician does write a separate RX and/or addendum letter, MAKE SURE it says the same thing as the LMN from the clinician. QUESTIONS???
- Sit to Stand Standing Frame, One position Standing Frames Supine, Prone, upright, Multi Position Standing Frames (Prone, Supine and upright) and Mobile Standing Frames all require similar documentation…this is where we start.
- You’d be surprised how many clinician’s leave off basic info, like client ht. & wt.
- Reviewers need to understand the process of elimination we (the team) did in our head…what we considered not necessarily trialed.
- Resources that are available to you 24/7 on our website. Snap shot of the Funding Tab on the website
- Here’s a sample LMN that is one method of set up. Note; top of page gives the reviewer a quick snapshot of the client
- Note; this LMN also does a nice job of briefly disscussing what other standers were considered and why they were rejected or worked.
- Know your payers source and what documentation they need/want.
- We do our best to share successful tools with clinician. Here is a ROM chart that has worked well in displaying ROM changes with a Standing program.
- Another form that has worked with payers who required a home trial. QUESTIONS ON LMN/J??
- Sit to Stand Standing Frame, One position Standing Frames Supine, Prone, upright, Multi Position Standing Frames (Prone, Supine and upright) and Mobile Standing Frames all require similar documentation…this is where we start.
- Website snap shot; Research. Each of these topics has a number after it, that number represents the number of studies listed under that topic. Once you click on a topic it opens to look like this…let’s open Cerebral Palsy…
- Each of these abstracts has a link to PubMed. We are not able to post full article on our website due to publication laws, but can share with individual clinician. If you are interested in the full article contact me directly.
- Here is a sample LMN that includes research citations.
- If you can read it on a website, so can a payer. Please do not copy sample letter. Instead use them to assist you in developing your own template. QUESTIONS???
- Okay, so you’ve done an excellent LMN, but the CRT supplier has just gotten back to you stating that the equipment was denied. What now… talk with the consumer, they must agree to lead the appeal. If they choose to appeal, here is the basic process.
- Compare the verbage in the denial to the documentation submitted. What did they not understand?
- Large appeal that I was involved in had a PAAT attorney, Parent, underage consumer, Supplier, with live phone testimony by the physiatrist and written testimony by treating PT and OT. It was successful after the appeal went to the Attorney General’s (AG) office. About a year for this process to be completed. This one appeal was able to changed the way power and manual w/c’s were provided through MN Medcaid. Don’t assume your appeal is for just your needs…it may change the lives of others also.
- How many know what PAAT is?
- Also on our website; PAAT & AT project directory
- Another resource for CRT
- Blurb about where their dollars come from