For your reference in advocating for protecting access to equipment for all CRT users, this guide was developed by NRRTS and their CRT user coalition, Unite4CRT. Be sure to contact your member of Congress to ensure that they understand how important CRT is to the independence and health of wheelchair users. Tell your story to bring it home.
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…
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.
In our last post, we discussed Medicare’s documentation requirements for custom wheelchair backs and cushions. Here we continue the series…
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.
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.
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:
The beneficiary meets Medicare’s coverage criteria for the wheelchair on which the seating will be installed.
The beneficiary’s condition and diagnosis meet Medicare’s criteria for custom seating. Specifically:
For custom backs – there are documented, significant postural asymmetries that are the result of a qualifying diagnosis.
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.
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).
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.