Each client is evaluated by either a physical therapist or an occupational therapist in conjunction with a RTS. As required or requested, an evaluation may be completed by the above mentioned team in conjunction with a Physical Medicine and Rehabilitation physician. All evaluations are initiated by a referral from a physician at which point the evaluation can be scheduled. On average, an evaluation lasts one and a half hours. Evaluations generally include, but are not limited to, a full seating evaluation in the client’s current wheelchair and seating system, a full mat evaluation in both supine and sitting, assessment of strength, range of motion, sensation, tone, and a skin inspection. Assessment of functional skills is completed in wheelchair and sitting on the mat, as needed. Further assessment may include pressure mapping, trial of various equipment, molded seating assessment, gait analysis, balance assessment and home assessment.
- A full mat evaluation is often completed by both the therapist and RTS to assess the following:
- sitting evaluation outside of client’s current seating system while still engaging gravity
- supine evaluation to fully assess general postures, range of motion, spasticity, etc in a gravity-eliminated position
- active/passive range of motion
- skin integrity (complete visual inspection)
- general physical measurements
- skeletal/orthopedic assessment
- Demo Equipment: High-end rehabilitation equipment often requires trials of various pieces of equipment to ensure the successful achievement of the desired therapeutic and functional goals of the client. Wheelchair Seating Service has a large inventory of equipment, including power wheelchairs, manual wheelchairs, a multitude of seating and positioning products, alternative drive systems, etc., that can be utilized to determine whether a recommended solution does indeed meet the client’s needs.
Wheelchair Seating Service has also established very strong relationships with manufacturers which allows the rehabilitation technology supplier (RTS) to often obtain equipment, which we may not already have, for further evaluation. This may require subsequent visits as we wait to obtain the equipment from the manufacturer.
As NRRTS members, we make every effort to abide by the NRRTS ethics to “do everything necessary to provide high-quality equipment, ongoing support and long-term service.” We feel that a full evaluation, including equipment trials, as necessary, is an integral component of the success of our clients in achieving full functional and clinical goals.
- Pressure Mapping: Evaluations of clients who have current skin breakdown or who are at risk for skin breakdown often require a more intensive evaluation of their seating system relative to their anatomy. This may require pressure mapping, to identify higher areas of pressure on the seating surface which may be cause for concern for potential skin breakdown. This tool is used to identify potential modifications to a current seating system or whether other seating solutions are more beneficial to the client. The pressure mapping consists of a map that is placed in between the client and the client’s seating system. The client simply sits on the system while it is connected to the computer. Areas of high pressure are located.
Wheelchair Seating Service is able to provide our client’s with state of the art pressure mapping through the use of the Roho Xsensor X3 Display.
- Molded Seating: It is occasionally recommended that a client obtain custom molded seating. If the therapist, physician, and rehabilitation technology supplier (RTS) determine that off the shelf seating will not achieve the desired goals for a seating solution, then a custom molded seating system is recommended. These are often used to accommodate postural asymmetries, orthopedic deformities, maximum support which cannot be achieved with linear supports, and/or skin protection.
Each RTS at Wheelchair Seating Service has several molded seating systems at their disposal including:
- In-Home Assessment: Certain equipment requires an in-home assessment by the rehabilitation technology supplier (RTS). An RTS will need to assess door widths, general access into the home, surfaces/flooring that client may be rolling over (inside/outside), access into bathrooms and bedrooms, general safety concerns in the home, and any other obstacle that may prevent the client from being able to fully utilize the recommended equipment in the home.
An in-home assessment is required for all clients who have Medicare and for whom a power wheelchair is being recommended.
Wheelchair Seating Service has a complete administrative team that specializes in verification of insurance and insurance benefits, coordination with medical professionals to obtain medical documentation, coding of all equipment for insurance submission, acquisition of authorization for rehabilitation equipment, and billing. If there are any questions on insurance or status on orders, clients can contact any Wheelchair Seating Service PSA at 734-971-8286.
Depending on the third-party reimbursement provider, some or all of the following documents may be required:
- Initial Prescription: All evaluations require an initial prescription for evaluation for rehabilitation equipment, wheelchair, and/or seating systems. This initial prescription must be written by either a physician or a nurse practitioner. The initial prescription may be hand-delivered to Wheelchair Seating Service or faxed to 734-971-8922.
- Letter of Medical Necessity: Most medical equipment requires a letter of medical necessity from a medical professional to justify the medical and/or functional need of the recommended equipment. At Wheelchair Seating Service, all evaluations are completed by a RTS along with a therapist and/or a physician. Generally, upon completion of the initial evaluation, the therapist will create a letter of medical necessity (LMN) justifying every component of the equipment that has been recommended during the evaluation. The administrative team at Wheelchair Seating Service facilitates having the LMN signed by the recommending physician. It can then be submitted to insurance, along with other support documents.
- Detailed Prescription: Upon determination of which equipment most adequately addresses a client’s medical needs, the Rehabilitation Technology Supplier will provide the Patient Service Assistant (PSA) with a breakdown of all necessary parts/items that are needed to complete the order. The PSA then creates a detailed physician prescription that is forwarded to the physician for review. The physician has the option of signing if she/he agrees or contacting the team to modify as needed. A physician-signed detailed prescription is required for any order prior to submitting to insurance for a prior approval.
- Physician Face to Face Mobility Evaluation and Subsequent Physician Notes: Medicare requires physician documentation to support all equipment requests. Patients who require powered mobility devices will need to have a face to face visit with a physician in which their mobility needs are discussed. The physician documentation from that visit must specifically state that the client’s mobility needs were discussed and a general statement regarding what the client needs and why. Medicare has established an algorithm (MS Word) for physicians to follow to determine which equipment is required and what needs to be ruled out if the physician is recommending powered mobility.
The documentation from the physician must be received by the RTS within 45 days of when the client saw the physician. If the necessary documentation is not received within that 45 day window, then the client must see the physician again and new physician notes are necessary.
In conjunction with the physician notes, a detailed letter of medical necessity (generally written by the therapist) needs a physician attestation statement such as “I concur with the findings”, as well as the physician’s signature.
- Prior Approval: Upon receiving all signed documentation from the physician and therapist, the WSS staff will submit the necessary documentation to the appropriate insurance to obtain a prior authorization for the recommended equipment. Certain third-party payers allow for a prior authorization to be obtained, assuming medical necessity has been met. The prior authorization provides an approval for payment for the requested equipment once it is delivered. If a prior authorization request is denied, an appeal process is available. The prior authorization process may require a few days to a few months depending on the particular third-party payer.
- ADMC: The Advance Determination of Medicare Coverage is a Medicare process which allows providers of durable medical equipment (DME) the opportunity to determine whether “medical necessity” has been met prior to dispensing the requested equipment. ADMCs can not be utilized for all equipment, but can be processed for items such as ultralight weight manual wheelchairs, tilt in space manual wheelchairs, and certain power wheelchairs. This is not a guarantee of payment. However it does give providers the knowledge that they have met “medical necessity” and that the likelihood of coverage for certain higher end rehab equipment will be provided.
Documentation that is required for submission for an ADMC includes:
- detailed prescription
- face-to-face physician evaluation prescription
- Physician progress notes from the face-to-face evaluation
- The face-to-face evaluation prescription and the progress notes from that face-to-face visit
- letter of medical necessity (LMN) and physician's written attestation statement of concurrence
Upon approval from either a private party or third-party payer, Wheelchair Seating Service orders the equipment. Time frames for receiving equipment may vary from a few days to several weeks depending on the custom nature of the equipment.
Once all of the equipment is received, it will be assembled in preparation for delivery and fitting with the client.
- Delivery/Training: Once the requested equipment has been assembled and a final insurance verification has been completed. The RTS contacts the client to schedule a delivery. Deliveries may include any fitting, necessary modifications/customization, instruction in use, safety assessment, pressure mapping, and scheduling of further training by either the RTS or the therapist.
- Timeline for Obtaining Equipment (PDF)
Wheelchair Seating Service provides a full service repair shop to support all equipment provided by WSS.
- WSS Service Policy (MS WORD)
WSS boasts a service repair team led by a shop manager who also is a Certified Rehabilitation Technology Supplier (CRTS) with over twenty years of experience in the rehabilitation technology field. The service repair team includes US Rehab certified service technicians to ensure knowledgeable technicians who can diagnosis and repair rehabilitation equipment. These technicians attend educational seminars for continued growth and development.