Must-haves for Letters of Medical Necessity

Now that you and your team have determined the best standing frame for you to use, it’s time for the Letter of Medical Necessity/Justification (LMN/J). The LMN/LMJ is a detailed document that one or more of your medical team jointly writes to submit to your insurance payer for authorization of the device. Unfortunately not all LMN/LMJ’s for standing frames are created equal. This important document must convey your specific medical need for a weight bearing program. It must also describe you and your life situation to the payer, without becoming a novel.

Here are some of the areas that must be included in the LMN/J:

• Include client name, date of birth, diagnosis, onset, height, weight, primary funding.
• Users level of function
• User’s medical issues and outcomes expected by use of the standing frame.
• Other less costly alternatives were considered i.e. ROM, splints, other methods of weight bearing
• Other medical intervention may be necessary if your client cannot receive a standing frame (i.e. surgeries, bracing, etc.)

Of high importance is the inclusion of:

• The types of standing technology that were considered and rejected.
• A description of the standers that were trialed, and why each trial either approved or rejected.
• Provide the user’s history of standing compliance.

Conclude the LMN with this information and stress necessity and importance:

• What type of standing technology is being recommended and why?
• What options/accessories are being recommended and why (i.e. lateral supports to assist with symmetrical alignment of the upper body, ankle straps for L/E alignment and safety, etc.).
• What is the prescribed standing program (i.e. minutes/hours per day, days per week)?
• Supportive research bibliography on standing if citing research
• Include the date and both the Therapist’s and Doctor’s signatures.

Here is a PDF sample of a successful letter of medical necessity for the EasyStand Bantam, that has all the items specified in our checklist above. Many more samples of successful letters of medical necessity for standing frames can be found on the EasyStand website.

For more details on what should be included in the LMN/J documentation click on these links:

http://www.easystand.com/health-benefits/research.cfm

Do you include all these items on your letters of medical necessity for standers? What other tips or advice do you have on how to successfully document a client’s need for standing technology? Please comment below.