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!