Documenting medical need for custom seating… part three

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The Ride Custom Back’s multi-axial hardware is highly adjustable to help optimize stability and postural alignment (overhead view).

In our last post, we discussed documenting the need for a custom wheelchair back or cushion vs. a prefabricated back or cushion.  Here, we continue the documentation discussion…

Part Three

Less Costly Alternatives?

Funding sources, including Medicare, expect clinicians to document the reason one custom product is selected over others that may be less costly.  Here are some of the differentiating reasons that Ride Custom 2 Cushions and Ride Custom Backs may be selected over other custom cushions and backs.

Ride Custom Cushion:

• Unlike other custom-molded wheelchair cushions, Ride’s patented and evidence-based mechanism of support helps to enhance sitting stability and performance, while reducing the dangerous forces of pressure and shear from at-risk bony prominences. Jane’s inability to perform a functional weight shift places her at high risk for pressure injuries, and the design of the Ride Custom 2 Cushion is critical to maintaining her skin integrity.

• Unlike other custom-molded wheelchair cushions, the Ride Custom 2 Cushion is modifiable in the field, without factory intervention or cost, to accommodate changes in Jane’s pelvic presentation over time.

• Unlike other custom-molded cushions, the Ride Custom 2 Cushion manages heat and moisture and can be cleaned and sanitized to provide a healthy microenvironment. This is critical for Jane Doe as she resides in a warm, humid client, and is at risk for pressure injuries.

Ride Custom Back:

• Unlike other custom-molded backs, the Ride Custom Back has a thin profile and multi-axial hardware which enables precise adjustment of lateral orientation to bring the head and neck to midline over supported residual scoliosis.  Jane requires the thin profile to maximize upper extremity range of motion and function, and requires the multi-axial hardware to adjust the position of the back to optimize her stability and postural alignment.

• Unlike other custom-molded backs, the Ride Custom Back manages heat and moisture, and can be cleaned and sanitized to provide a healthy microenvironment.  Jane’s warm and humid environment make this medically necessary.

If you need assistance with documentation review for your Ride Custom Back and/or Cushion order, we can help, and at no cost to you!  Contact our Reimbursement Department at (866) 781-1633 x 312.

Documenting medical need for custom seating… part two

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The Ride Custom 2 Cushion is made specifically to match each individual’s unique shape to help decrease long-term skin risk and aid in sitting stability for improved functional performance.

In our last post, we discussed Medicare’s documentation requirements for custom wheelchair backs and cushions.  Here we continue the series…

Part Two

In the written therapy evaluation — why Ride Custom over prefabricated cushions and backs?

The beneficiary may present with: specific body measurements, significant postural deviations, contractures, pelvic tilt, obliquity, rotation, etc. that cannot be accommodated by a prefabricated cushion or back. 

These presentations should be well documented to demonstrate the reason a prefabricated cushion or back will not provide sufficient skin protection and/or postural support.  Documented trial and failure of lower level equipment is beneficial.

Example:  Jane Doe presents with a very pronounced anterior pelvic tilt, a left pelvic obliquity, a left lumbar convex scoliosis, a right convex thoracic scoliosis, a marked thoracic kyphosis, and a forward head. Her lower extremities assume a position of abduction. Her legs exhibit a leg length discrepancy with the right lower extremity being shorter than the left. 

There are no prefabricated wheelchair cushions that will accommodate these postural deviations to provide sufficient stability and pressure management. There are no prefabricated backs that will provide accurate contour to accommodate and support Jane’s posture. 

With lack of sufficient pelvic and trunk support, Jane is at risk for developing progressively more severe postural asymmetries as well as pressure injuries. In addition, a poorly fitting prefabricated seating system will severely limit Jane’s ability to independently perform mobility-related activities of daily living. 

A Ride Custom 2 Cushion and Ride Custom Back will be made specifically to match Jane’s complex shape, helping to decrease long-term skin risk and aiding in sitting stability for improved functional performance.

Continue reading, go to part three.

If you need assistance with documentation review for your Ride Custom Back and/or Cushion order, we can help, and at no cost to you!  Contact our Reimbursement Department at (866) 781-1633 x 312.

 

Documenting medical need for custom seating… part one

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Ride Custom Cushion and Back made for a pediatric client.

Navigating the U.S. Medicare guidelines for documenting the medical need for custom seating can seem daunting.  We’ll break it down for you here.

Part One

To start, Medicare requires that a beneficiary needing custom seating is seen by a Physical or Occupational Therapist to evaluate the seating needs, in addition to a physician. The documentation generated by the physician and therapist will need to contain three primary pieces of information:

  1. The beneficiary meets Medicare’s coverage criteria for the wheelchair on which the seating will be installed.
  2. The beneficiary’s condition and diagnosis meet Medicare’s criteria for custom seating. Specifically:
    1. For custom backs – there are documented, significant postural asymmetries that are the result of a qualifying diagnosis.
    2. For custom cushions – there is a documented, current pressure ulcer or history of pressure ulcer on the lower back, sacrum, hip or buttock, OR documented absent/impaired sensation in these same areas, OR documented inability to perform a functional weight shift, as the result of a qualifying diagnosis.
  3. A statement clearly explaining why a prefabricated seating system will not sufficiently meet the medical need of the beneficiary. (This piece of information cannot come from the physician alone, it must be in the written therapy evaluation).

Continue reading, go to Part Two!

If you need assistance with documentation review for your Ride Custom Back and/or Cushion order, we can help, and at no cost to you.  Simply contact our Reimbursement Department at (866) 781-1633 x 312.

Rich Salm: director of sales and education

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Rich Salm (center) at a recent show, flanked by team members Shelly Myers (left) and Joe Bieganek (right)

Ride Designs announces the promotion of Rich Salm, ATP, to the position of director of sales and education.

A long-time veteran of the Complex Rehab Technology (CRT) industry, Rich has made significant marks in many areas including CRT business ownership,  business development, contract negotiations, advocacy, NRRTS board membership… and the list goes on!

Rich joined the Ride team one year ago as sales manager, and quickly gained significant traction in forging fresh directions and improved sales support / performance throughout the organization. His initiatives and skills in education and support of international business development went far beyond his job description and earned him this promotion. Rich now oversees all sales and education functions within Ride Designs. Look for great things to come.

Congratulations, Rich — we loved your reaction to the surprise announcement! 

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Precisely formed: Custom Backs

Ride Custom Back forming process

Ever wonder how the Ride Custom Back is made? Check out this video…

Hot, high-grade prosthetic plastic is vacuum-formed to a specific client’s back shape. The shell provides stability and is the outermost layer that hardware will mount to. Once the shell cools, Ride technicians will cut the back out and begin adding the materials necessary for breathability and comfort. It’s just one part of the process involved in delivering the best custom products available to wheelchair seating users.