Bundled pricing came about after a review of how frequently orders, purchase orders and prior authorizations were having to be revised as a result of a flawed sequence in the normal process of providing custom molded seating systems. The current process is as follows:
- Client is evaluated for seating and mobility.
- Determination for custom molded seating is made after all lesser costly alternatives are ruled out.
- Therapist and ATP guess what specific options and components are necessary for the seating system.
- Lengthy order forms are filled out, quotes are generated and LMN is drafted based on that guesswork.
- Prior authorization is generated and submitted based on the specifications the clinical team thinks the client needs.
- Medicaid reviewer reviews detailed line items to determine if medical necessity is established.
- Prior authorization is granted.
- Client returns to clinic for shape capture and actual specifications for the seating are determined and differ from the original ones quoted and authorized.
- The supplier, therapist, manufacturer and reviewer must all revise their work to accommodate the changes in the order. Order, order form, purchase order, LMN and prior authorization must now all be revised to accommodate the changes. This creates more work for everyone and delays order fulfillment.
- Once revised PAR is approved, then PO can be issued along with revised order form to the manufacturer for production.
- Additionally, ATP’s and clinicians may over spec the system in the beginning to ensure that they have the necessary authorizations in place to accommodate for the unexpected changes identified at the time of shape capture.
There is tremendous inefficiency in the current process and all of the detailed line item work for the ATP, therapist, funding specialist, reviewer and manufacturer is largely wasted. A non-clinician may ask why the shape capture does not occur at the time of initial evaluation. There are many reasons for that. Number one is that it is imperative to deliver custom molded systems as close as possible to the shape capture date, because the client’s posture can change. The longer the time-frame between shape capture and final delivery, the higher the chances of that new system failing and needing to be remade. Also in busy clinics, the scheduled appointment time may not allow for the additional time required to perform a shape capture. Moreover, clients with complex needs oftentimes lack the endurance for a seating and mobility evaluation AND a shape capture all at one appointment.
Bundled pricing allows the sequence of events to be placed in the correct order, simplifies the process for all concerned and eliminates a lot of wasted time for all stakeholders. Bundled pricing provides for a flat rate price that includes all of the most frequently ordered options and accessories. All high cost options are excluded from the bundled price. Using bundled pricing means that the supplier and therapist can specify and prescribe custom molded seating utilizing as few as two line items, one for the seat and one for the back. The Medicaid reviewer only has two line items to review.
The sequence utilizing bundled order forms then flows as follows:
- Client evaluated for seating and mobility.
- Determination is made for custom molded seating.
- No detailed order form needed at this point. Streamlined manufacturer’s quote, order, LMN, prior authorization are all generated and submitted. Reviewer only has to review two line items.
- Medical necessity determined and authorization granted.
- Client is seen at clinic for shape capture and specific specs are determined.
- Detailed order from generated and submitted to manufacturer with PO for production.
Bundled pricing eliminates a tremendous amount of duplication of work for all concerned and speeds up the order process.
