As our providers continue to work hard to provide equipment to our patient population there are a few items that we need to consider.
1. Make sure you are working with the patients to give them the most appropriate opportunities for equipment that is needed. Even if it is denied on a frequent basis have the patients sign a release and work through the process to make the insurance carrier do their job.
2. Work closely with the therapist to make sure the patient gets each and every item needed to help them perform their daily living tasks as if they had no impairments.
Even if the products that are needed are not always approved that does not mean they do not need them. It is our responsibility as a professional rehab community to work towards the highest level of functionality for the patient. In this article there is some great advice on how to handle these issues and continue the good fight for the patients best interest.
New emphasis on patient release forms for complex rehab
by: Elizabeth Deprey
Friday, April 27, 2012
YARMOUTH, Maine – If complex rehab providers want to help preserve access to equipment and services for Medicaid recipients, they need to do a better job getting patients to sign release forms, industry stakeholders say.
NCART’S Medicaid Committee has been working to challenge denials and overturn negative policies in various states, but without release forms, its efforts often hit a wall.
“That’s been our biggest issue,” said Rita Hostak, an executive committee member for NCART and vice president of government relations for Sunrise Medical. “They’re the only ones with the right to challenge—not the supplier, manufacturer or even the clinician.”
Patients often hesitate to sign release forms, stakeholders say, because they don’t want a legal battle that might impact their ability to get benefits.
That’s why providers should make release forms part of the intake process—instead of trying to convince patients after they’ve been denied equipment to sign the dotted line, stakeholders say.
“Afterward, it’s hard to try to explain the process when the patient’s in a negative, stressful situation,” said Hostak.
The other hurdle for NCART’s Medicaid Committee, stakeholders say: Clinicians aren’t documenting the need for certain equipment when they know it won’t be covered, which leaves NCART without proof of a problem.
“I can’t challenge (a policy) if the need was never documented,” said Hostak.
NCART is spreading the word that providers should have release forms and proper documentation in place in case they need to fight for their patients, something that’s likely to happen more and more frequently.
“Medicaid’s always been an issue,” said Don Clayback, executive director of NCART. “In the past year, states—as they continue to wrestle with their budget pressures—are being forced to take more drastic measures when it comes to their budget.”