Question
With all of the Medicare and Medicaid changes, do you have to complete extra documentation to get power wheelchairs and seating systems approved?
Answer
Yes. This happens with many other funding sources as well, not just Medicare and Medicaid. Smaller funding sources will often follow Medicare guidelines and adopt their changes. Years ago, our Letters of Medical Necessity (LMN) were not nearly as detailed. We could say someone had a pelvic obliquity or scoliosis and get the funding. Medicare now requires that you document in great detail the severity of their deformities and how that impacts their function. They want specific angles and degrees in the documentation.
You may also need extra documentation in instances when you need custom frames or seating that are not "standard" such as bariatric equipment.
Another issue with funding is that there are too many LMN and not enough reviewers. For example, in Illinois every month 15,000 Medicaid LMN cross the desks of 4 reviewers. This is too many for them to process. In order to sift through this large quantity, they will deny claims that are not filled out correctly or they are unable to read. This is not a true denial, but just a lack of information denial.
Overall, therapists need to make sure that they are very thorough with their documentation, are aware of what the reviewers are looking for and clearly document this neatly and legibly.
