A while back I spoke with a nurse case manager about the need for a stander for her client. After a lengthy discussion about the individual’s medical justification; the nurse case manager informed me that standers turned into coat racks, and thus this payer program should not cover them. Further [..}
Funding-Making Your Own Luck
by on May 16, 2011
Who deserves to stand? A sixteen year old with cerebral palsy, a middle-aged male with a T7 Spinal cord injury, a seven year old with metabolic syndrome? They each sit in there wheelchair all day long and are at risk for many types of immobilization issues from contractures, pressure sores, [..}
You are the Consumer, it is YOUR choice
by on April 25, 2011
“There are always two choices, two paths to take. One is easy and it’s only reward is that it’s easy”. ~Author unknown On a daily basis, I speak to consumers with disabilities who are looking to purchase Complex Rehab Technology (CRT). Some are attempting to decide what they should do [..}
Letter of Medical Necessity for Kid’s Glider Speaks for Itself
by on April 14, 2011
A letter of medical necessity (LMN) or letter of justification (LOJ) is a detailed prescription that a therapist or physician writes to be submitted to the insurance provider. The letter should be client specific and not just a list of the medical benefits of standing. To help you in writing a [..}
Self Advocacy (with a little help from my supplier)
by on March 21, 2011
Jeff told his DME (Durable Medical Equipment)/CRT (Complex Rehab Technology) supplier, “That’s crap! I will not accept a denial from my insurance company for the stander. I’ve got to have the stander at home to keep my leg range of motion. What can I do to fight their decision?” What is [..}
Fueled by Advocacy – CELA 2011
by on February 22, 2011
Shane was denied power assist wheels for his manual wheelchair in Minnesota. Five different consumers cannot gain appropriate funding for their standers from private insurance in New York. Elizabeth’s power wheelchair was down coded to less expensive wheelchair due to Medicare’s “in the [..}
Funding for Standing Frames (Presentation)
by on December 8, 2010
Part of my job at Altimate Medical Inc. is to help educate people on the process of purchasing a standing frame and writing a letter of justification for a stander. Below is a PowerPoint presentation on Funding & Documentation for Standing Frames that was recently presented to clinicians and [..}
The Enigma of Competitive Bidding
by on November 2, 2010
While I am a firm believer in free enterprise, competitive bidding simply isn’t competitive. If it were, there would not be a cap. Think for a moment about one of your dearest family members. Imagine if you will, that they were unfortunately, suddenly in grave need for a wheelchair, standing [..}
NCART Medicaid Summit Emphasizes Team Approach
by on October 15, 2010
I just got back from the NCART Medicaid Summit in Nashville. It was nice to see many familiar faces. It would have been even nicer to see more new faces willing to work with industry veterans to push forward Complex Rehab Technology education with the public payer sector. As I expected, NCART [..}
Take Action to Change Flawed Competitive Bidding Program
by on October 5, 2010
It’s been a while since my last blog on Medicare’s competitive bidding program for Durable Medical Equipment (DME). It’s important to realize that this program has moved forward despite its many flaws! It will decrease access to products and services that are vital to consumers function and [..}
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