The Fight for Independence

When I was in school, one of my favorite subjects was the American Revolutionary War. I loved that an upstart bunch of colonists rebelled against British rule and declared that they had the right to be free. I admired the colonists’ resourceful nature in finding (sometimes unlikely) allies to help them in their historic struggle. I pictured George Washington’s army shivering at Valley Forge, starving and demoralized, yet keeping the faith and emerging stronger and more determined than ever in the spring.

Perhaps due to the circumstances of its birth, this nation has always cheered the underdog and embraced seemingly hopeless causes. In fact, this industry is full of providers who, day after day, campaign for the assistive technology that they know will make a difference in their clients’ lives.
Unfortunately, as Washington had his Valley Forge, so are mobility and rehab providers now facing their own huge battles, in the name of funding. So this month, we’re tweaking our annual case study issue and presenting case studies from a reimbursement point of view.

We went to several rehab manufacturers who are well versed in the reimbursement wars, and asked how providers can build a strategic case for technology that’s traditionally difficult to fund. The manufacturers elected to speak on four topics: independent mobility for very young children; standing chairs; ultralightweight chairs; and equipment currently without HCPCS codes.

The authors’ advice gives insight into what can make a difference when you submit a claim. They talk about everything from thoroughly understanding coverage criteria, to seeking clinical and educational allies, to paying careful attention to word choice while filling out forms.
I’d heard this “semantics” advice as well at National Seating & Mobility’s (NSM) annual symposium. One of the RTS’s there suggested that when we talk to funding sources or parents about giving independent mobility to very young children, we should not use the word “drive.” When we say “drive the chair,” this RTS noted, everyone pictures a toddler driving a car. They get alarmed, and the idea of independent mobility gets buried before you have the chance to explain.

I hope no toddler has ever been denied independent mobility due to one misinterpreted word, but after interviewing our reimbursement experts, I understand that our ability to clearly represent the situation can absolutely impact whether or not equipment gets funded. We need to make payors “see” what we see when a 2-year-old client sits in a power chair and moves independently for the first time in his life. Payors need to “see” and understand that child’s joy and his parents’ new-found hope. They need to understand how independent mobility will affect the child’s intellectual and physical development, and that safeguards by RTS’s, equipment manufacturers and caregivers can make this ride a safe one.

So we hope these case studies will help you in your continuing efforts to fight the good fight on behalf of clients who need you…and especially clients who you just know could benefit from certain technologies that are reimbursement underdogs right now.

This article originally appeared in the July 2008 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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