Complex Rehab and the Current Reimbursement Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Clinical Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome Decision Making for Optimal Outcome
Mar 31, 2015
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, and Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal OutcomeClinical Decision Making for Optimal Outcome
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
By Melissa Aitken, MPT
&
By Chip Fiske, CRTS, ATP
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
I. What is Complex Rehab (defined by
NCART)?
It is the scope of practice that addresses each
of following areas: Wheeled mobility Seating and alternative positioning Ambulation support
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
Environmental controls to meet the physiologic and functional needs of people with disabilities
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
Review of Complex Rehab (PMD coding)• Group 1 - Light Duty
(designed for intermittent use indoors)
• Group 2 - Basic Daily Mobility(designed for daily use indoors
• Group 3 - Complex Rehab(designed for complex disabilities- indoor use)
• Group 4 - Complex High Activity(designed for complex disabilities- indoor/outdoor use)
• Group 5 - Complex Pediatric(designed for pediatric clients)
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
• Medicaid Requirements for Complex Rehab
CRTS to sign eval PT/OT to perform eval
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
II. Ethical Decisions for Optimal Outcome
Do no harm – Hippocratic Oath Provide compassion and respect for
human dignity and rights through competent medical care
Be honest in all professional interactions
Shall support access to health care for all people
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
III. Financial Decisions for Optimal Outcome
Reimbursement decline• Medicare• Medicaid
“You reap what you sow”• Sowing good – result good referrals• Sowing bad – result NO
REFERRALS
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
Why Employ an ATP in these tough economic times?
• Most current on insurance guidelines
• Most expedient in performing evals
• Produce better results = more referrals in long-run
• Most experienced in wheelchair/mobility evals
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
IV. Clinical Decision Making for Optimal Outcome
As an ATP (assistive technology practitioner)
As a PT (physical therapist)
C
Inappropriate fitting of wheelchairs can be costly
As a Assistive Technology
Practictioner…
Complex Rehab and the Current Complex Rehab and the Current Reimbursement Decline: Ethical, Financial, Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal and Clinical Decision Making for Optimal OutcomeOutcome
As a Physical Therapist…
Remembering the focus is on: client centered vs. product driven not placing client in the NEWEST,
GREATEST, and LATEST providing comfort for the patient
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
Wheelchair Clinics
Advantages of ATP/PT as team time efficiency for patient and staff less clinical errors better marketing for future business making partnership/better relationship
with one another to build trust
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
The crux of why certification for ATP’s provides more assurance than those who don’t?
Validates individual’s qualifications based by RESNA’s standards
Provide practice-related knowledge-based requirements against which an individual can be assessed
Seating is more than “sitting”
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
Complex Rehab & the Current Reimbursement Decline: Ethical, Financial, and Clinical Decision Making for Optimal Outcome
…AND THRIVING!