Seating Clinics (16:38)
This lecture will teach how to evaluate the right wheelchair for a patient. Reimbursement and vendor rates have dropped; Medicare and Medicaid will only pay one flat fee regardless of the number of visits. Diane Warns describes competitive billing procedures, billing codes, and custom equipment.
Funding Custom Wheelchairs (17:50)
Wheelchair and mobility device prescribers should ask patients about limitations, balance issues, functional improvement, stairs, and equipment currently in use. Evaluations for wheelchair and mobility devices can come from primary care providers, physical therapists, and other medical professionals. Warns uses anecdotes to illustrate the importance of picking the proper characteristics for a wheelchair prescription.
History of Patients and Measurements (24:03)
Warns explains the importance of probing a patient's history before forming a chair recommendation. Medicare needs up-to-date justifications for new chairs and changes in chair type. Wheelchair assessment must include out of chair evaluation of the patient.
Points of Access & Pressure Mapping (25:19)
Types of propulsion options include: self-propelling, joysticks, sit and puff, head switches, and eye gaze. Warns talks about pressure mapping a wheelchair user. Re-positioning wheelchair users is important to maintain skin integrity and good health.
Pressure Mapping Systems (10:02)
Learn pressure mapping systems that are available. Warms discusses numerous treatment options for lowering pressure in seating.
Problem Solving Seating Issues (10:41)
Scavenge parts from old chairs including wheels, seat belts, nuts, bolts, hanger, footplate, brakes, and arm pads. Warns describes treatment modalities for leaning forward, providing lateral support, and low seat height.
Equipment Options (06:11)
Change the seat to back angle, or tilt in space, before using a chest harness strap. Medicare or Medicaid will only pay for a lap tray if a clinician documents the patient needs an upper extremity support system.
Types of Wheelchairs (27:13)
Vendors can receive advanced determination agreements for K-5, powerchairs, and tilt in space chairs. Warns describes the benefits and drawbacks of the ultra-lightweight, Breezy Ultra Four, Quickie Two, sports wheelchair, Quickie Iris, and K-4s.
Types of Wheelchairs: II (29:53)
The Quickie Zippie Two and the Quickie Zippie TS are highly customizable. Power wheelchair types include front, mid, and rear wheel drive, rear-wheel drive hybrid based, Invacare FDX, tilt assist, and DeGage. Warns discusses how to justify not allowing a patient to receive a power wheelchair for safety reasons.
Power Mobility Devices (19:40)
Medicare will advocate purchasing a power scooter before transitioning to a wheelchair, but physical therapists need to ensure the patient can transfer in and out of the device correctly. Invacare requests a mold be made of a patients seat using electronic pens or beads. Types of cushions include J-Basic, J-Go, and the Evolution.
America's Team Mobility Wheel Chairs (22:24)
Eric demonstrates the Breezy and TiLite wheelchairs. Natural Fit Hand Rims provide a better grasp for patients than a normal wheelchair, but insurance will not pay for them. Tire options include pneumatic tires, foam, and solid tires.
Specialty Wheelchairs (13:39)
Most vendors prefer not to provide power assist manual wheelchairs because Medicare changed its policy to rent-to-own. Tilt and Space wheelchairs are caregiver driven and any vendor can obtain one. K-5s can be purchased outright whereas K-4's require competitive bidding.
Rehab Wheelchairs (07:37)
Alleviate pressure by reclining the backrest and tilting the patient. Insurance does not pay for seat elevators regularly. Show the advantages and disadvantages of each brand model to a patient so they can make an informed decision.
Wheelchair Cushions (16:05)
Cushion options include foam, air, and gel based and are dependent on patient diagnosis. Brands include ROHO, Comfort M-2, J-fusion, and PS cushion; knead a gel cushion to ensure equal amounts in pressure spots. Eric recommends having an expert make a patient's mold.
Seat Backs and Head Supports (11:52)
Patients who have significant obliquity or scoliosis will need a custom-molded seating system. Head and cervical supports should be provided for patients who travel in moving cars and tilt and space wheelchairs.
Transportation in a Motor Vehicle (16:48)
Requirements for chairs to be considered crash tested and transit approved include: four tie downs, withstand a 30 mph impact, and allow for positioning of vehicle mounted safety belts. Companies want to start asking for certifications of federal approval. Warns describes issues that physical therapists document when applying to Medicare for a wheelchair and accessories.
Physical Therapist Form: Steve (20:43)
Warns provides an example of letters of medical justification where funding was approved. Ask for everything that would be helpful and compromise when hearing back from the Centers for Medicare and Medicaid Services. The physical therapist and doctor need to sign the letter.
Vendor Forms (23:29)
Vendors must supply measurements to CMS. Warns reviews a typical order form and a home accessibility form. Physical therapists need to explain why each portion of the wheelchair is necessary.
Basic Prescription (09:09)
Warns reviews a seven-element form. Medicare requires that a patient who wants a wheelchair must have a face-to-face meeting with a doctor for that specific reason. Vendors must confirm the office possesses a Resna Certified ATP on staff.
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