What It All Means
If it's Medtrade season, it's time for our annual reimbursement issue. For an English major like me, who limbo'd under the college mathematics requirement by passing Liberal Arts Math, this is always a challenging topic. This year, with so many numbers flying around, I feel as if I'm back in class. Will 33 CMS codes (18 original + 15 new Sept. 1 codes) + 7 NCART codes eventually = 1 new coding structure that will work for everyone? And what are seating professionals to do when 9 new cushion codes + 0 announced allowables = using the old codes for now?
So rather than trying to figure out this new math, I'll step back and remind you why you're sweating the codes, clinical coverage guidelines and missing allowables in the first place.
I spent a recent Saturday morning at the home of 4-year-old Jacob Meslovich. My photographer was there for a photo shoot; I was there to supply breakfast muffins and Spiderman stickers to keep Jacob and brother Nick, 8, happy and photogenic. And I talked to Greg and Jeanne, the boys' parents, who rattled off Jacob's mobility equipment.
Jacob has a new chair that fits him ("New Car"), a first chair that he loves but has outgrown ("Old Car") and a school bus transport chair that no one loves because it's big and bulky (no name). Greg looks with fondness at that well-used first chair with knobby tires. "It changed his life," he says no fewer than three times during the morning. "All of a sudden, he could move around in his own house."
Jeanne says they paid cash for that first chair, because Jacob was two and a half at the time, and their private insurance didn't believe in buying a chair for a child less than three. When I open my mouth to protest, Jeanne waves me off: "Oh, we got reimbursed." But my sense of justice lasts only until she says, "They paid a third of the price."
Still, Greg and Jeanne count themselves lucky. Jacob has his chairs and a walker that he uses to scoot around the living room and retrieve M&Ms. Their home's front- and back-door concrete ramps were made free of charge by a friend. Greg installed a grab bar at the front window so Jacob can look outside. Indeed, Greg and Jeanne say they're fortunate. They point out that families with fewer resources, or who cannot doggedly keep after funding sources, have kids who just do without.
So to those who listen in on CMS' Open Door meetings, who write Congresspeople about restricted access, who volunteer for coding committees or clinical coverage coalitions, who join or help RAMP, NCART, NRRTS, RATC, et al - know that you're really working for Jacob. And more importantly, for all the kids and adults who don't have anyone else to fight the good fight.
This article originally appeared in the November 2004 issue of Mobility Management.