Powered Wheelchairs- Driving Options

Although the Wheelchair has not significantly changed over the past 10 years, the technology that allows them to operate has.  There is a saying in our company, if a person has any consistent independent movement and the desire, we will get them mobile. 

Even with all the negative pressures in the Medical industry, innovation is no longer limited by the big four wheelchair producers. There are many switch and electronic companies that lead the charge in offering more creative ways to drive powered mobility.  Additionally many universities have gotten involved and have been stretching the options....from using an Ipad, eyegaze and video game controllers to EEG, and Voice Control.

Traditionally the joystick has been used to operate a powered wheelchair. When users could not control a joystick, there was switch control and sip and puff.  Later head control using proximity switches and modified head joysticks.  Modifying a joystick to be mounted on a arm or footrest was common.  In the past decade, fiber optics, magitek, light touch joystick has been used. More recently game controllers (ie PS4 and Xbox) have been converted to allow individuals to drive their powered wheelchairs with these systems. Many of the new technologies that are emerging are adapters, and supports to hold current control devies.

In the past few years, we have seen the Wii balance board used as a input device for children who when lean, can control a powered wheelchair.  Although this is not yet in the market place it certainly offers a wider range of options for those who have limitations in access or those who do not understand movement through space.   We are seeing many universities experiment with EEG as when you communicate and think, the waves are consistent and can be converted into a signal in which to drive a powered wheelchair.  Speech communication has also been used to drive a powered wheelchair.   Most recently, a university has been piercing people's tongues using it as a way to drive a powered wheelchair.

Unfortunately most of these newer technologies have not yet become commercially available or even made it through FDA consideration.  All these technologies are exciting for people who have lost the ability to move independently.  It is truly exciting to see more and more options available which will allow more access and integration.

We are really excited to see people thinking outside the traditional box, and are  looking forward to these new technologies that will enable more people to drive and be independent.

This Article was written by Carey Britton, he can be reached at cbritton@wheelchairguys.com  or at 954-946-5793.

Is it Important to be Certified?

It can be an unconscious decision to entrust someone who is an authority in the field we need assistance from. Whether it is building a house, having a major renovation, having your automobile repaired, having a medical procedure; there is value and peace of mind knowing that your choice is certified and reputable.

You may find it surprising that when it comes to Seating and Mobility equipment; many insurances including local Medicaid's do not require any certification or licensing that the person recommending, and providing the equipment has no certification.  At the time I am writing this, only Medicare and a few Private Insurance carriers require at a minimum an A.T.P. certification.  The ATP (Assistive Technology Provider) is a RESNA certification that requires an individual have some basic experience in DME (Durable Medical Equipment), and who sits for a test.  This certification was established to set a minimum standard to ensure that the person who was involved with the equipment has some experience, and who is requires continuing education. 

As you can imagine, some individuals take this test to gain the minimum standards required by Medicare and never increase their skills as it is not a requirement. Is that enough? There are several people who have been in this industry for decades that have great experience; however when you are looking for an expert, how do you separate a veteran ATP versus one who passed the test last week?

If you are needing basic Seating and Mobility equipment then maybe a newbie can help, but if you are facing challenges; wouldn't you want someone who you can trust? 

The NRRTS organization felt that the ATP was a good starting point, but felt that Seating and Mobility is a specialty and felt there needed to be a higher standard.  NRRTS established the RRTS (Registered Rehab Technology Supplier) which you become after meeting their standards and are listed on a Registry.  After two years of being registered, with no complaints against you, you become a CRTS (Certified Rehab Technology Supplier).  The CRTS has been the gold standard when it comes to finding an expert Seating and Mobility Specialist. 

In the past few years, there is a new SMS certification. This Seating and Mobility Specialist Certification is tested on experience, and was created by RESNA.  This test requires years of experience as there is no manual, or book to read to pass the exam. 

I find it puzzling how if you want compression stockings, only a certified fitter can help you; however with a custom wheelchair with many insurances anyone can fit you for this equipment.  I am happy to see that it is changing, but in my eyes not soon enough. Many lobby that the reason more insurance carriers do not mandate these certifications are that they may not be enough ATPs around.

There was a time where every community had an amazing physician, or an amazing therapist who were the expert in Seating and Mobility; and where the equipment supplier only had to know about their product(s).  Today, with budget cuts, and increased productivity demands; the Physician and Therapist do not have the time or incentive to be the expert. They have higher demands and expectations on the Equipment Supplier for measurement, assessment and recommendation of equipment.

The Equipment Supplier is now suffering from the same budget cuts, and now have a reduced menu of services which depend on the funding source. These insurance pressures are forcing providers to provide what is minimally necessary to maintain a level of profit for the company to ensure their doors can stay open. 

At the end of the day you have to decide who will help you, who will recommend equipment equipment that will affect your life.  The equipment supplier has to make a profit for survival; however your equipment supplier must have your best interests in mind.   The certification(s) are a layer of protection for the consumer, not only for the knowledge and ongoing education.

Not unlike another Medical Professional there is a board that they are accountable for and where their licenses or certifications can be taken away and where it will affect their ability to work. 

This Article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center. He can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com. Find us on Facebook.

Father’s Day, a Day to Appreciate Dad.

I am sitting here reflecting on My Dad who I lost a year after He and I started South Florida Mobility Inc. D/B/A Active Mobility Center in 1992.  My Dad was an electrician by Trade, and was able to teach me a lot about mechanical and electrical equipment., which I use every day.  I was lucky to have a Dad and Family that gave me the opportunity to succeed and find my passion in helping others maximize their abilities. It was my Dad who found a Medical Equipment business for sale, when I was dismayed about medical school. 

On this Father’s Day, spend some time reflecting on how your Dad has made you better, and appreciate what you have. 

Happy Father’s Day from Active Mobility Center. 

Tilt in Space has almost replaced Recline on Manual Wheelchairs.

Before tilt-in-space wheelchairs, reclining wheelchairs were dominant when a person was a high risk for pressure sores and needed to change their position in the chair during the course of the day. The drawback of reclining wheelchairs is that when reclining the backrest, it causes a sliding effect on the user. The back shears against the users pelvis and against their back. This can cause sores on the back and pelvis if the user's skin is susceptible. Additionally recliners can cause a client to slide down and out of the wheelchair creating positioning and functional issues.

Since the introduction of the Tilt-in-Space wheelchair; recliners have taken the back seat. The only time recliners are prescribed over tilts is when a client needs to recline for feeding, issues with blood pressure, hip limitation, daily activity or severe deformity.

Tilt-in-Space takes a person sitting upright and tilts the whole seat frame back. This allows for the pressures on the buttocks to be redistributed to the back of the user. The tilt-in-space also allows for correct posture throughout the entire range of tilt in space. The tilt with the assistance of gravity helps force a users back, and hips to the rear of the wheelchair helping maintained midline posture. With tilt there is no shear effect since the user's body never changes position against the support surfaces of the wheelchair.

There are chairs now that offer both tilt and recline that can offering maximum benefits.

This article was written by Carey J. Britton, ATP/SMS, CRTS for Active Mobility Center.  Any questions or comments, call (954) 946-5793 or email cbritton@wheelchariguys.com .

We Still Need your Help to Make a Change in CRT- HR 942

I am sitting here on the first day of June, thinking of how far we have come in our quest to change Complex Rehab Technology.  CRT is a relatively new term, which covers custom configured equipment including ultra light weight wheelchairs, powered mobility and seating and positioning equipment. 

It is mostly understood that, CRT is not a order and drop equipment, and requires skilled staff to help with the evaluation and assessment, the gathering and submission of paperwork to insurance funding, the ordering, assembly, delivery and fitting of this specialty equipment. 

Unfortunately our industry has not done enough to police itself and has a black eye, as it is lumped in with DME.  Every month you can see in the news DME suppliers investigated for fraud and abuse.  It is unfortunate that instead of CMS doing a better job screening their suppliers, they have placed higher and higher requirements which are negatively affecting the beneficiaries. What CMS/Medicare does, is adopted by all other insurance carriers.

I am excited to tell you at this moment we have 130 House Co-signers and 15 Senators who have Co-Signed on to this Legislation. This is a great start but we need more to make this legislation to be important enough for Congress to move on this.

None of us know if/when we may need these products and services; and there is a real concern that if things do not change, then this industry will certainly change; and possibly disappear.

A friend of mine reminded me that, Orthotics and Prosthetics went through this Journey several years ago, and it took them over a decade to be recognized and have their products/services separated from basic DME and are understood that it takes a special group of people to take care of those with special needs.

Take a moment to sign on to the petition to separate CRT. If you want to be move involved please contact me and I can put you in touch with several groups who are leading the charge to change CRT.

This Article was written by Carey Britton, ATP/SMS, CRTS for Active Mobility Center. He can be reached for comment at (954) 946-5793 or at cbritton@wheelchairguys.com.

Repetative Strain Injury

This type of injury is becoming more and more prevalent in our society, from carpal tunnel syndrome to shoulder injuries suffered by a growing number of aging individuals in manual wheelchairs. It has always been the stance of medical professionals and insurance carriers to limit the ability of walking impaired to manual wheelchairs as their principle means of mobility. It makes sense that if you are walking impaired, that your calorie burn to intake ration is less, and using a manual wheelchair will help burn more calories, and help keep the user physically fit.

As these clients who were prescribed only manual wheelchairs for their mobility are aging, many are finding themselves having severe pain in the shoulders, which is being diagnosed as repetitive strain injuries. In addition to propelling their wheelchair throughout the day, within their homes, into the community and workplaces; medical professionals are realizing that the human shoulder has limited capacity for these functions.

The movements of pushing a wheelchair, compounded with independent transfers, and daily routines it generally too much for the human shoulder to handle.

It has always been my belief that there is a balance between manual and powered mobility for individuals who are confined to a wheelchair, and dependent for their mobility. From a mobility stance, having the ability to use manual mobility within the home and work place, as the chairs are smaller and more maneuverable is certainly an advantage. Manual wheelchair burn more calories, reducing the potential for excess weight gain; and increases strength allowing for independent transfers. Powered wheelchairs allow a user to travel across greater distances, which put users at risk for repetitive strain injuries.

Repetitive strain injuries can cost funding sources tens of thousands of dollars, not to mention loss of employment to the wheelchair user. This loss could be simply reduced by providing both a manual wheelchair, and powered system to long term users of mobility aids. It would make sense (and reduce costs) by providing this equipment to specific diagnosis; that generally develop these types of injuries.

A possible solution to save money and benefit the wheelchair population, would be to provide both types of equipment; and prompt an education program for potential injury groups to explain the benefits of using both types of equipment; thereby reducing medical care costs, and risk of obesity from inactivity.

This article was provided by Carey Britton, ATP/SMS, CRTS from Active Mobility Center, located in Pompano Beach, FL. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com

What can you do to help fix Funding for DME.

The item coalition, as well as NRRTS, RESNA, NCART, and countless other groups and manufacturers have been fighting a battle for the mobility challenged community. For years, it has been up to our industry to police itself, and there have always been a few bad apples that have ruined our system, reducing our credibility and have forced CMS to take action. As a long time supplier, I remember the signs “FREE LIFT CHAIR”, which providers abused until Medicare blocked the code, and made it difficult for consumers to get these items.

Over the past few years, since powered wheelchairs have become fashionable and attractive; suppliers had found a loop hole which could be very lucrative. We have all seen the people who receive powered wheelchairs, but can still walk. We have also recently witnessed many providers becoming indicted for billing for this equipment and never providing it to their patients.

I have repeated over the years, to my congressman, to organizations, consumers, and professionals; that the only solution is to rid the industry of its bad apples. The problem stems from the manufacturers, who see increased demand of their equipment through outlets who do not offer service, customization, or any choice to the consumer. If manufacturers demanded their suppliers were credentialed, and provided adequate service with the capacity to follow up the product; our industry would be very professional and respectable. Instead today, suppliers are looked at as people you cannot trust; and only in it for the money.

There is a genuine concern about the competitive bidding program that Medicare is initiating. As a supplier my concern is that to put something out for bid in an industry which is already providing (in many cases) substandard equipment; the allowable for equipment will plummet. Competitive bidding means that in a community all providers bid their lowest price they can provide a service for. Since many suppliers are providing non-US equipment, the price ceiling would most likely be set for these lower imported products.

The obvious concern here is that when reducing costs so much, what happens to the service. What many individuals do not understand is that most equipment that is provided (by responsible providers) requires an assessment from the provider, with a team consisting of a physician, therapist, and family to provide the best solution for the patient. When you set a capped amount on equipment, both the choice of equipment and the specialty of customizing, and fitting a mobility product will disappear.

What most people don’t know, is that most physicians and therapists are not familiar with equipment and depend on the supplier they are working with to recommend the most appropriate equipment. In reality the equipment that is being prescribed, is left up to the supplier to choose. When you reduce the funding, and reduce the choices, you will lose the specialty providers; and have only a delivery system. Would you rather a delivery person drop off your equipment, or a specialist who can instruct, train, adjust, modify and make suggestions to you?

The competitive bidding issue still has a long battle ahead, as there are too many uncertainties; like if you award a company a particular demographic; and they turn out to be a bad provider; what is the recourse. When you award one provider the work for an entire area, you will certainly force many of the other providers out of business. So how do you replace a provider that fails to perform?

The larger picture may be that by providing cheaper products that will be outsourced to non US countries, our Gross National Product declines. To spend billions of US dollars on healthcare for most of that revenue to be sent outside the US , is not good for our country. Even worse, is the amount of unemployed, skilled workers from local equipment suppliers, and from national manufacturers.

Now is the time to get involved, voice your concerns to legislators; tell them of the importance of local providers who can supply, fit, repair and customize products. Nothing in this world is free, when you see these ads for free power wheelchairs, no cost to you, qualifying people who can still walk- turn them in to Medicare. We cannot be blind and turn away as this problem is not going away; and when you need Medicare benefits they are not going to be there.

This article was provided by Carey Britton, seating and mobility specialist for Active Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com

Thinking Out Side the Box.

It amazes me how many times I hear clients tell me that their old equipment suppliers/providers told them NO it couldn’t be done. For many industries this may be the case, but for our industry, the custom seating and positioning industry; telling people NO, can mean the difference of independence, or the equipment not being used.

Of course our company says NO, when it liability or safety is a concern; but we offer our client’s the option to customize their equipment to the extent is makes their lives easier or more independent.

Our company advertises its ability to provide custom mobility and seating equipment. If we advertise this we must be able to deliver. Our company continues to offer off the shelf products when needed, offering molded seating systems, customized seating frames, tilt in space, recline, elevating seat, and standing options.

To further our out side of the box thinking, we have the ability to add, specialty lighting to equipment. Many of our clients are children and young adults who were robbed of the ability to own, customize and drive a car. We have been offering neon and other lighting packages to accessorize their rides. Kicking it up a notch, or octave is mounting stereo systems, amplifiers, and speaker systems to the chairs for the entertainment of themselves and their peers.

A new addition, has been adding rear view camera and display systems for clients who have difficulty seeing behind the chair. For may wheelchair users, there is a big blind spot behind their chairs. We have been offering a camera that mounts to the rear of the chair which is attached to a LCD screen on the front of the chair to enable clients to see what is behind them.

Our company still strives at providing systems that fit, and interact with it’s users. We challenge ourselves everyday in enabling our clients; maximizing their abilities!!!!

This article was provided by Carey Britton, Seating and Mobility Specialist for Active Mobility Center, he can be reached at 954-946-5793 or at cbritton@wheelchairguys.com

What Can You Do to Help Make a Positive Change

If you know me, you know that I attempt to do the very best at whatever I choose to do in life.  In regards to my work, I am passionate about helping others through Seating and Mobility.  Over the past few years, there has been an attack by CMS/Medicare on this small industry that positively affects so many people; allowing them to live a more productive and independent life.  With the help of Active Mobility, I have been able to spend time advocating and lobbying for access to these services.

The number one (1) complaint that we here at Active Mobility Center, is that it takes too long to receive new equipment, and that the hoops needed jump through are unbearable.  As an industry we have done a poor job educating the public on how to advocate for themselves. We, as a collective group, always want to satisfy our customers, avoiding all the negativity of the increasing pressures.  When there was more of a margin/profit on medical equipment, we could hire more staff and facilitate equipment faster; however now with these changes- we have to do more with less.

These increased funding pressures, combined with the amount of requirements now to qualify and prior authorize equipment is making this process much more lengthy. CMS/Medicare had created new watch dogs who are bounty hunters only profiting by finding errors in paperwork, so suppliers have to spend much more time on the details; than the actual equipment provision.

Over the past few years, you may have heard of a program called competitive bidding. This program, no longer only a Medicare problem; has been finding it's way into the private sector; and if Obama's plans go into affect in 2015, will affect state medicaid programs. 

As of April 1st 2014, Manual Tilt in Space wheelchairs as well as some other DME products will become capped rentals. Many providers have already voiced their concerns that they will no longer be able to accept this and will no longer provide these services.

Equipment providers can no longer afford to be the sole Advocate for the users of medical equipment. The pressures exerted have taken the profit out of the system and where equipment users will need to get involved to avoid access to these services.  There are many ways that you can get involved, from contacting CMS/Medicare, your state and local representatives, or attend lobby groups to show how important this is to you and others.

Staying in touch through NRRTS.org, NCART.us or other similar organizations can help guide you and help your voice be heard.

This article was written by Carey Britton, ATP/SMS, CRTS for Active Mobility Center. He can be reached for comment at cbritton@wheelchairguys.com or at 954-946-5793.

Is Medical Equipment too Expensive?

I have seen many posts lately on Face Book and in Blogs about the high prices for DME and Medical Equipment. I have seen comparisons to Sport Aid and other online pricing compared to the brick and mortar companies. 

As a tax payer, and after taking an Ethic course and discussing the outside perception of the costs of Medical Equipment; I understand the concerns.  It is hard to fathom that a powered wheelchair may cost as much as a car, that an ultra light weight wheelchair may cost $3000. 

That being said, have you seen how much a refrigerator, furniture or a racing bicycle may cost?  I have a friend that has a bicycle that costs $5K.  I understand that the racing bicycle may be considered a luxury and where a wheelchair is not; but there are a lot more bicycles sold yearly than the same custom wheelchairs. Bicycles do not have the same requirements and liabilities as do wheelchairs.

As a Complex Rehab,  DME supplier and Board Member of NRRTS, I see the other side of the equation.  Generally Medical Equipment is funded through Insurance and all insurance companies follow Medicare guidelines. Unlike the Sport Aid type companies, we are forced to comply with all Federal, State, Local, Accreditation, and Insurance guidelines.  Unlike Sport Aid, we have to follow the clinical model and have to provide a report that builds a case for medical necessity, we have to chase all the paperwork, submit the request to funding, help with any appeals, order, assemble, deliver, fit and then submit the claim for billing; which can take up to one year to be reimbursed. 

Retail companies, advertise their products, take a deposit or the entire amount up front, and ship the equipment to the customer.  There is little cost and risk in this process. Catalog and On-line companies can be anywhere, allowing them to reduce costs, they do not have to have the insurance coverage, they do not need to be accredited, inspected, or follow the same standards as Insurance providers.

There are costs associated with playing the game. In retail, it is all about price and value. When providing equipment through insurance, you have to have a location that is certified, inspected, accredited, bonded and insured. The costs above the rent, staff, trucks, equipment, parts; etc. is the Professional and Liability Insurance ($10-$20K / year), Accreditation ($3-$5,000/year), Medicare and Medicaid Licensing ($1K/year), Bonding ($1K/year). There are regular audits by the insurance carriers, which cost much time, and expense in fulfilling the requirements and ensuring payment for services.

DME companies offer and provide knowledge, education, and their experience to improve the quality and successful outcomes. I am the first to agree that there are not enough safe guards in the DME world, which is why NRRTS is aggressively promoting trying to carve out Complex Rehab Equipment from DME.

There are studies that have been conducted, showing that in Complex Rehab that the net profit for most DME's are under 7% which is very low in comparing to other industries. This offers very little room for growth, pay increases to staff, or any additional benefits to workers. 

Competitive Bidding was introduced, reducing payments for many DME products. After the first year 33% of the winning providers went out of business as they could not afford to stay in business.
It is important to remember, that DME companies purchase the equipment they are providing, and help with all the insurance paperwork and do not receive any compensation until the equipment is delivered.  All of the labor costs from the intake, evaluation, quoting, requesting medical documentation, submission for approval, ordering, assembly, and ensuring there is a service staff to help with concerns is all funded through the sale of the product.  It is a semi-flawed system, however if insurance companies paid a lower rates, and considered labor hours for the entire process; the price of the equipment would be higher than it is now.

This article was written by Carey Britton, Seating Specialist for Active Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com.

Active Mobility Center Knows the Power of Networking

People buy from people they trust, and they need to get to know you before they trust you.  This process makes it difficult for companies who depend on traditional advertising. 

If you have tried print, video, social marketing, networking, and exhibits, I am sure you will have found that networking and exhibits where you are face to face with people increase your odds in building a relationship of trust which will likely recruit more customers.

Many people do not know they are networking every day of their life.  They tell people what they like and what they don't like.  In business, advertising is expensive, and networking can dramatically help increase the number of people that you can explain why you are valuable.

If you have a clear message, and can back up what your promise you will create an amazing word of mouth business. 

This article was written by Carey Britton with Active Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com

Active Mobility Center says to Emb(race) Everyone

Emb(race) is an event put on by Stand Among Friends at FAU to support diversity.  Active Mobility Center was pleased to support the 4th annual race on February 23rd of 2014. Hundreds of people came out to support this all-inclusive family fun event that features a 5k & 10k walk/run and one mile family walk; all to enhance the lives of people with disabilities.

Their programs help them transition to greater independence; learn work, technology and social skills while emphasizing their talents, interests and education. We help them realize and achieve their career aspirations and widen their social opportunities--so they can experience a meaningful life, both personally and professionally.

Through a comprehensive employment program, state-of-the-art assistive technology program and lab, vocational evaluations and community outreach efforts, Stand Among Friends helps people regain their independence and dignity. Over 1,200 individuals have participated in our programs and we have placed over 500 individuals in active employment.

The Disabilities Center is located on the campus of the Florida Atlantic University in the Christine E. Lynn College of Nursing in Boca Raton, Florida. The Center, which is designated as a Center of Excellence in the State of Florida University system, coordinates research efforts to develop new approaches, products and services for people with all disabilities.

Thanks to all that came out ad supported this event. Carey Britton, seating and mobility specialist, can be reached at cbritton@wheelchairguys.com or 954-946-5793.

Active Mobility Supports PBC Schools at the S.T.A.R.S. Conference

 

Active Mobility Center was honored to support the Palm Beach County Schools 9th Annual S.T.A.R.S. (Start Transition And Realize Success) conference at John I Leonard High School in Lake Worth, Florida.  This year was amazing, with a student panel who discussed their struggles, successes and made suggestion on how to make it better for the next generation. 

 

The group was very wise at 20-23 years old; Burn Your Path, Follow your Dreams, and Have Fun. 

 

One of the speakers said it is important to have Patience, Advocate for yourself, Belief that anything is possible, Setting Goals, Building a network of support.

 

We were priveleged to meet some very inspiring young people, and were able to network with many professionals to increase the value we can offer to our customers.

 

Carey Britton, Seating and Mobility Specialist can be reached at 954-946-5793 or at cbritton@wheelchairguys.com . 

Active Mobility Center at the Muscle Walk in Palm Beach

The Muscle Walk !

Last week, Active Mobility Center participated in the MDA Muscle Walk at Roger Dean Stadium in Jupiter Florida.  The Muscle Walk supports the efforts of the MDA helping to research treatments and an eventual cure for this terrible condition.

This year Active Mobility Center will be more visible in the community, listening and learning on how we can be a more valuable resource to South Florida. Please help us by making any suggestions on how we can be more valuable.

This article was written by Carey Britton with Active Mobility Center in Pompano Beach. Any questions or commetns can be directed to Carey at cbritton@wheelchairguys.com or (954) 946-5793.

Be Friendly to Others this Februrary

Happy Valentines Day to you all.  I met with Dr. Teri Cooper over the weekend, who in addition to sharing information about an amazing new company with products that are making anti-oxidants inferior; she discussed how people have lost the ability to communicate.

Blame it on technology, or the fear of being hurt; people today are not has friendly. You can see this when you head down the sidewalk, and wave or say hello; most people give you a weird look. 

I would suggest in the observance of Valentines Day, that you make the effort to reach out, and be nice to anyone you encounter during the month of February.   Remember how good you feel when someone goes out of the way to show kindness.

Powered Wheelchairs and Medicare Guidelines

Medicare Guidelines for Powered Wheelchairs

Let's start by stating that Medicare (CMS) is operated by the Federal Government, they set codes and fee schedules to all Medical Equipment and Services.  They determine what is appropriate and necessary based on reported information about the patient.  With any government agency there are requirements to meet their determination of medical necessity.  All other insurance providers follow the governmental plan, so everyone should be concerned when Medicare makes a change.

Mobility Related Activities Of Daily Living

This is a fancy way of saying what you do in a day. MRADLs as they are commonly called, need to be reported to any insurance as this is how someone at Medicare can create a mental picture of the beneficiary needing the equipment.  Although Medicare is diagnosis driven, there is a lot of variance within a diagnosis. One person with MS (Multiple Sclerosis) maybe ambulatory, and the other in a multiple function powered wheelchair. Mobility Related Activities of living is a list of items that you can and cannot provide without the equipment being recommended.

For an individual who cannot ambulate, getting around the home is a challenge. Additionally they may or may not be able self feed, toilet, transfer, get out of the home, or some other activity of living.  These items help justify or deny the new equipment needed.

Medicare Hierarchy of Equipment (Complexity)

You may have heard Least Costly Alternative to solve medical needs. This is true with Medicare andstandard wheelchair, then light weight wheelchair, then ultra light weight wheelchair, then scooter and finally a powered wheelchair.   The powered wheelchair is on top of the mountain and as such requires the most documentation to support the need.
all insurance providers. They have created a chart, from basic to complex equipment that is easy to follow.  If you cannot ambulate, you may use cane, if a cane does not provide enough support, maybe a walker or crutches will help. I this does not allow you to perform your activities of daily living, then a

A Good Medical Equipment Supplier

This has never been as true as it is today.  In the past your supplier was just that a company who provided and serviced the equipment. With all the new rules/requirements,  your equipment company will navigate the system and reduce the amount of time involved.

Documentation Requirements

This is where you need a good team to help you. Documenting and Submitting a request to Medicare is a challenging process, and over the past few years has gotten much more difficult. You will need to find a supplier that will help guide you through this process.

Medicare now requires a Face to Face (F2F) visit for all powered mobility equipment. This requirement will soon affect most other medical equipment as well.  The Face to Face is a visit with
your physician where you are present, and where the reason for the visit is to discuss Seating and Mobility Equipment.  The physician must document what he does in a normal visit; vital signs, list of conditions, list of needs, etc.  The physician must document your ambulatory status, your need for assistive technology ranging from the cane, walker, wheelchair, scooter or powered wheelchair.  He must document how you presented to him in the office.  If you physician has a challenge with the level of documentation required, they may refer you to a physiatrist (physical medicine doctor), or a physical or occupational therapist who can further describe your conditions.

In today's medical model, most physicians are not familiar with seating and mobility equipment, so after they provide the Face to Face document, and 7 Element Prescription, they generally refer a patient to a physical or occupational therapist. 

During this therapy evaluation, the equipment supplier should be sending their RTS (Rehab Technology Supplier) to be present to be part of the team who assesses and recommends the most appropriate equipment to fulfill your mobility needs within the Insurance Guidelines.

The therapist is responsible, through their letter of medical necessity (LMN) to paint the picture of the mobility and functional status of the patient. They will document the patent's range of motion, their posture, and ability to reach and perform daily activities of living.  This document will be very detailed and is what the insurance reviewer will be looking for to approve or deny the equipment requested.

From this point, the RTS will print out all the manufacturer order forms, and create a detailed product description. This lists all the equipment the patient requires, based on the assessment, and lists the insurance code that references the item. This report will be sent to the therapist who will ensure that the LMN discusses each item listed, and will send their LMN back to the supplier.  The supplier will send the LMN, along with their reports back to the physician for review and signature.

Once all documents are received, they are sent to Medicare for prior authorization.  When Medicare responds, it is either with an approval, denial or request for more information.  If approved the equipment is ordered, of denied, an appeal can be submitted. If more information is requested, the supplier with the beneficiary's help can gather more information from the physician and/or therapist.

Time Line

This can be a lengthy process as there are many professionals involved. Beneficiaries need to have patience through this process.   Prior to the F2F requirement equipment was evaluated, and approved within 30 days.  Unfortunately this is no longer the case.  Physicians are busy, and getting an appointment can take weeks, waiting for the documentation from the physician can take time, if they send you to a specialist; between scheduling and reporting this can take weeks.  Waiting for an authorization has taken up to 30 days. Additionally several weeks;  ordering, assembling and scheduling for delivery.

Provider Certifications

Medicare requires a minimum certification to assist with Powered Mobility Equipment evaluations.  This requirement is expected to be increased; and at the time of this article it is a ATP; Assistive Technology Provider. This staff member must be present and involved through the evaluation of the equipment.  You should know that there are providers who have higher qualified and trained individuals above the ATP.  These individuals are the SMS and CRTS  SMS stands for Seating and Mobility Specialist, where they have went beyond the ATP and trained to the highest standard.  The CRTS, Certified Rehab Technology Supplier, is harder to receive, and shows the commitment, dedication and experience.

Five Year Rule

Like most insurance providers and DME (Durable Medical Equipment), the life expectancy of the usefulness of the equipment is five years.  This means that Medicare will not fund a replacement for this term.  There are exceptions to every rule, however short of a theft, or natural disaster; a beneficiary will wait five years to receive new equipment. In the event the equipment you have no longer solves your mobility equipment, you may be eligible for equipment that his more complex.

Service and Follow Up

With any mobility equipment, your supplier needs to be your friend. They will be needed for maintenance, service/repair, and for modifications to your equipment over the five years. Prior to several changes, it was easier to switch providers after receiving the equipment. Since the equipment supplier has the documentation sent to Medicare for support that the beneficiary needs the equipment, a new supplier may require to you go back through the process as Medicare audits all providers. If the service provider cannot prove the equipment the beneficiary is using is medically necessary (has all the documentation from the doctor/therapist/etc), then Medicare could recoup the funds. 

All Insurances are following these guidelines, and for this reason beneficiaries must be more involved and aware of this process. There has been a lot of change, and continues to be changes at Medicare that affect your ability to receive quality equipment.

This article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center. He can be reached at cbritton@wheelchairguys.com or (800) 326-4463.

Running Out of the Gate

2014 is here, and things are not slowing down.  Active is looking at the industry as the glass is half full, and where there is great opportunity.  We are seeing many national companies buying up local companies and intimidating the local providers like Walmart.  Insurance is changing, and we are now learning the affects of Obama Care.  There is constant pressure to change, and the staff at Active are embracing this not to ensure survival but to become better.

Over the next few months, our customers and partners will see some major changes. Our office is having some renovations to increase it's display space, increase the retail and accessories available to our customers.  We are improving our inventory management system. A face lift on our website will be completed by February to offer a more friendly site to navigate and access the information.  An event calendar will be added and will show local and regional activies, and events to allow the community more involvement.  You will see a higher level of community visability and involvement. More interaction between our customers and business partners to help us become more valuable to the community and remove any inefficiences. Last but not Least, we will be adding more FUN.  We understand that the Medical Equipment business can be sterile and we want to improve the experience not only for our customers but also for our staff.

We realize change is occuring with or without us, and understand that we need to be ahead of the curve to ensure that we are here for our customers, partners and health care professionals.  We also know that what we do is very personal and that our customer wants a company who listens, who cares, who is local, and who will be there to support and educate them.

Thank you for your continued support. We understand that there is a choice for Medical Equipment and know we have to continue to earn your business and referrals.  Please continue to send in comments or suggestions on how we can continue to improve to be your number 1 choice.

This article was written by Carey J. Britton, ATP/SMS, CRTS from Active Mobility Center. Active Mobility Center, located in Pompano Beach, Florida provides and supports; seating, mobility and specialty rehab equipment.  Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

Looking Forward to a Great 2014.

2013 has been an exciting year filled with change. Active has expanded into more clinics, we have make improvements in our technology, in our systems and in our improved office and service center.  We have partnered with organizations to improve our community involvement and are continuing to listen to our customers and referal sources on how we can get better and become more valuable.

We see great opportunities within the community where we can become more of a resource, where we can add value, and where we can continue to grow.

We look forward to continuing to hear from the community on what you want, on how we can get better and how we can earn your business and support.  Our team will be continuing to get better, and creating the best experience posisible.

With Sincere Gratitude,

The Staff at Active Mobility Center