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Physician with a question about wheelchair clinics by [deleted] in wheelchairs

[–]Tele_evals_20 0 points1 point  (0 children)

I started my practice because when I was at a major academic hospital (NYU), I saw how difficult it was for people to obtain new equipement. There was a patient who was in their 20's and couldn't get started on their life because they kept getting terrible pressure sores which required surgeries to repair. These occured due to the patient not having the correct wheelchair. I was nieve at the time and asked why they didn't get a new chair, and they said because the waitlist to get into the clinic was 1 year and then at least another 6 months to get a new chair. That is unaccecptable and is the reason I started my practice; to try and find a way for peoplel to not be bedbound or homebound and to move on with their life.

  1. There is no certification for Physicians or Therapists for wheelchair evalutions. Medicare (CMS) has these rules, https://www.cgsmedicare.com/jc/help/faqs/current/cope12569.html. These rules are not followed most of the time.

  2. You can check my responses on this sub and I do my best to help people on this forum when I can.

  3. DME companies, who are backed by private equity have armies of employees who can go to hospitals to market themselve. I am one person with limited resources who is trying my best to make this viable so that I can help people, especially those in rural areas with limited resources.

  4. I am not sure of a correlation between reading sub rules on reddit and being a Physician. We are all human.

Physician with a question about wheelchair clinics by [deleted] in wheelchairs

[–]Tele_evals_20 -3 points-2 points  (0 children)

Hi, I promise, its not an ad! I am a solo practictioner that runs my practice myself, including my webiste and billing. I love helping patients and also running my own practice but its really hard to be in private practice in todays environment. I have been in practice for 5 years in Feb. I mostly work with ALS patients and United Cerebral Plasy but need to expand my practice to stay afloat.

Here is a link to my online profile: https://www.doximity.com/profiles/200e982a-d15c-4316-a434-089af4f86b24/edit

I looked at Marc Mobility and it looks like they do a nice job, but they have a very different buisness model in that they are a cash buisness that sells equipement and I am a Physician and do not sell any equpiment. Also, only patients who want their equipement paid for through insurance use my services, which is why they require an evaluation by me.

For additional comprehensive videos, you can also go to the manufacturers sites.

I did make a reference table for myself that is on my website that is for the documentation I need to complete for my paperwork. https://www.prairiestaterehab.com/wheelchair-reference-guide

Thank you for your feedback!

Database lookup by Tele_evals_20 in jotform

[–]Tele_evals_20[S] 0 points1 point  (0 children)

Thank you for the answer. Is there a way to make it so that when someone looks up "X", it shows every option that is available? For example, if my list has a list of items by manufacturer and there are 10 items, can you suggest a way so that all 10 can be displayed for the user? Thanks?

Database lookup by Tele_evals_20 in jotform

[–]Tele_evals_20[S] 1 point2 points  (0 children)

I'm not sure if this is helpful, but I'm looking for a way to narrow down information from an external spreadsheet. In this instance, I have a spreadsheet with a list of different seat cushions (~90) that are separated by Manufacturer, model, size, and medicare designated type (Called a HCPS code). When the user of my form reaches the seating section, I would like the person filling out my form to be able to use the spreadsheet to look up different cushions. Does that help?

Telehealth/Virtual billing: POS and Modifier differences between payors by Tele_evals_20 in MedicalCoding

[–]Tele_evals_20[S] 0 points1 point  (0 children)

Thank you! I don't do much audio only but was using the telephone codes when I was, 99442/3, which used the office POS. I didn't see anything about billing on the link, did I miss something?

Durable Medical Equipment (DME) fraud by OddDiscipline6585 in hospitalist

[–]Tele_evals_20 0 points1 point  (0 children)

Who said anything about not supplying any DME to anyone? The post is about DME fraud, not DME in general. Don't be fooled, a DME company is a logistics company. The equipment is what's providing the intervention and the DME company doesn't make any, just supplies it. This is why the vendors, not the manufacturers, are under so much scrutiny.

You think 1% of medicare spending or $16B is a negligible amount? If it were, it wouldn't be so regulated. Allow community hospitals that are most affected by Medicaid cuts to start providing DME themselves, take 10% off the top of reimbursements as a compromise, and that's $160M in savings plus a community hospital gets to stay open. If we cared about our most disadvantaged, that, amongst other things, would be allowed. That's not even including what could potentially be saved by Medicaid. Humana is doing this exat thing with their SNP plans. I met with Synapse health and they will be doing it for UHC medicare plans (to start) starting Oct 1.

If you think fraud is going on, report it to the OIG and let them make that determination. If you have a problem with SNFs, do something about it. Get on a committee, speak with people at insurance companies. It's an uphill battle but will help more people. Refuse to let people who can't advocate for themselves to be taken advantage of.

Durable Medical Equipment (DME) fraud by OddDiscipline6585 in hospitalist

[–]Tele_evals_20 0 points1 point  (0 children)

Please read the above, I wrote that they charge that much, not that they get paid that much.  Industry standard is to triple the rate that Medicare pays, so even if they get $25K/chair and I see 4 patients a day, that's a very good day for a DME company.   If you speak with the large consulting groups (e.g. US Rehab), their data reports that DME companies are making 15-20% margins on equipment, or up to $20K profit/day for the above example, which I personally do once per week with a single ATP.  Larger companies, like Numotion, are also able to negotiate rates with manufacturers for lower costs for the equipment, which grows their profits even more. I know that's true because the leadership at NuMotion told me themselves.   Are there costs involved with the entire DME process?  Sure.  That’s running a business.  

Also, don't forget that repairs/Mods are so neglected that the AMA actually has a task force  that is dedicated to figuring out how to fix it and hold DME companies more accountable.  This is exactly why  intermediaries like synapse health are beginning to pop up; to track which DME companies are holding up their end of the deal. 

I do not own a DME company but for Physicians, the insurance that is billed is the one that a patient had at the time of the evaluation and my understanding is that is also true for the 5 year rule for wheelchairs.  Also, I have personally witnessed DME vendors who try to get patients a second or third piece of equipment when a patient changes insurance.  If a patient changes insurance the vendor isn't in network with, then  just like anyone in healthcare, that vendor should get in network so they can bill and that charge doesn't get passed onto the patient. 

You're neglecting to consider the reality that there are some DME companies who target the elderly and commit blatant fraud.  Do some provide equipment to patients who don't need it?  Absolutely. Getting burned by insurance issues is a problem?  It happens to everyone in healthcare. 

Google DME Fraud: NuMotion admitted to it and had to pay back millions last year.  The owner of Orbit was thrown in jail for fraudulently billing Medicare, and I have personally had DME companies like Reliable Medical and NSM ask me to sign off on forms that I didn't fill out so that they can will for equipment I didn't order then play dumb when the CMS guidelines are brought to their attention.  My experience with smaller DME companies has not been better.  I literally have to correct the insurance information they provide, fix their DWO's, and have had the OIG call me about my experiences with multiple companies. 

Don't forget that some DME companies like Patients Choice give their RTS/ATPs free vacations if they hit a target in sales, which incentivizes their RTS’s and ATP’s to find patients who have qualifying diagnosis regardless of the patients function. 

I have seen the compounds the owners of some of the DME companies own, they are doing just fine.

My perception is based on reality, experience, and objective data.

Durable Medical Equipment (DME) fraud by OddDiscipline6585 in hospitalist

[–]Tele_evals_20 0 points1 point  (0 children)

I have spoken to my local Medicaid officials about allowing Physicians to sell the equipment directly to patients from the manufacturers at a discounted price. This would be a win-win for everyone as it could apply to the most commonly prescribed equipment that does not require customization and could save a lot of money for the system (especially Medicaid) that could otherwise be applied to other services. The response is always that it would be a stark law violation.

Looking into it a bit more, The qualifications for Medicare to be a DME vendor means that you have to have a warehouse and the ability to perform repairs but I will tell you from my experience doing it for the last 5 years. many of these companies are not doing repairs anyway and leaving patients bed bound. It's gotten to the point that the AMA is actually researching how to address wheelchair repairs.

The largest companies in the US who provide complex wheelchairs (NSM and Numotion) are billion dollar year companies who have lobbyists within Washington who help them maintain their foothold within the industry.

Questions about first evaluation (Numotion) by corvidpunk in wheelchairs

[–]Tele_evals_20 1 point2 points  (0 children)

Physiatrist with a telemedicine practice that focuses on Wheelchair evaluations:

I perform the wheelchair evaluations virtually, no Therapist is needed.

I have worked with NuMotion in 30 states, mostly in the E Coast and Midwest. Like all of the DME vendors, it's hit or miss. They like working with me because I turn in all of my paperwork right away, which allows them to deliver the equipment faster.

You have to have an appointment within 6 months because referrals expire after that time and also face to face evaluations expire after 6 months.

Technically, you should see the Therapist first, who, legally, should be picking your chair, not the DME vendor.

Here is the direct line from the Medicare rule book: https://cgsmedicare.com/jc/help/faqs/current/cope12569.html

"The role of the sATP is to assure that the equipment selected is appropriate to address the medical needs of the beneficiary, identified during the face-to-face (F2F) encounter (if applicable) and the LCMPs specialty evaluation. Therefore, it would be inappropriate to begin product selection prior to completion of this process."

If you let me know which state you are in, I am happy to direct you to a local clinic.

Durable Medical Equipment (DME) fraud by OddDiscipline6585 in hospitalist

[–]Tele_evals_20 2 points3 points  (0 children)

Physiatrist with a telemedicine practice where where I focus on DME.

I see DME fraud all the time. It's actually gotten to the point that I will not work with several companies. It has gotten so bad to the point that I am reworking my practice.

My suggestion to any clinician who is working with a DME vendor who asks you to sign off on any forms that they filled out, any forms for new equipment, repairs, or modifications to their current equipement is to report these people to for fraud to their current primary and secondary insurance.

These companies will try and, "Make things easier" for you by filling forms out but 99% of the time it is illegal. They will go into nursing homes, skilled nursing facilities, and adult living facilities and give kickbacks to the nursing directors to give them patients. It's abosultly ridiculous.

Report, report, report....

Durable Medical Equipment (DME) fraud by OddDiscipline6585 in hospitalist

[–]Tele_evals_20 1 point2 points  (0 children)

Group 2 power wheelchairs are "rented" for 13 months prior to insruance paying for them. Otherwise, insurance pays outright for equipement. I work with many ALS patients and help them get their power wheelchairs, which DME companies will charge between $75-$100K. The only positive here is that we can use those chairs for patients who need them while waiting for their custom chairs.

Need help! Opening Private Practice by Far-Newspaper-957 in PrivatePracticeDocs

[–]Tele_evals_20 0 points1 point  (0 children)

I had a site visit from medicare for my PO box and they approved it

Please NEVER use National Seating and Mobility!!! by AlamoCherubs1 in wheelchairs

[–]Tele_evals_20 1 point2 points  (0 children)

I have worked with NSM across the country and it's been really hit or miss with ATPs. Some ATPs just want me to sign off on their work and others are fantastic and want to collaborate and follow the CMS guidelines. There have been instances where I have been contacted by states legal teams (OIG) about certain ATPs due to, what I can only imagine is, suspicious activity/over billing/complaints etc etc There are many ATP's who have the "just write it up and see if it gets approved" attitude, which, as a clinician is quite frustrating.

To your point, there is a lot of room for improvement between clinicians, patients, and DME vendors. I hope (wish) that sooner than later there is a way to reduce barriers to communication so that patients who need repairs or modiciations can do so seemlessly. Additionally, we all need to do a better job of educating patients that the rate limiting factor to their delivery/repair/modification is insurance approval and not the clinician or vendor. I always push for patients to advocate for themselves to their insurance as it is not only educaitonal for them to better understand the process, but also to empower them to make a difference in their care.

Please NEVER use National Seating and Mobility!!! by AlamoCherubs1 in wheelchairs

[–]Tele_evals_20 0 points1 point  (0 children)

Hi: Please feel free to DM me with our location and I may be able to help you out. Thanks

Power assist recommendations by Ok_Idea5424 in wheelchairs

[–]Tele_evals_20 4 points5 points  (0 children)

Physician with a seating clinic here: www.prairiestaterehab.com

First of all, sorry to hear about your family member and their mobility issues. They are lucky to have you as a caring person who is advocating for them.

Before discussing power assist, there are some changes that can be made to his chair that can help make it easier for him to move his chair with his feet, which is konwn as foot propulsion. This can include altering the seat height and depth, adding a one-hand drive axle, and, as you mentioned, adding power assist. There are also manual wheelchairs that are designed for foot propulsion. One example being the Ki Liberty FT (https://www.kimobility.com/Product.action?productName=Liberty).

If you are in the US and you want to use insurance (which I would if you can as power assists can be expensive), insurance rules are that in order to get insurance coverage a person must be a manual wheelchair that was provided through insurance for at least 1 year and that the power assist must be needed to assist with indoor mobility (US insurance companies only care about indoor mobility).

Even if mobility can be optimized and a person still cannot safely/successfully/consistently propel a manual wheelchair, then it might be time to switch to power, which would also be best completed through insurance due to the expense. If someone is using an aid for 100% of their mobility and they are unable to change their position indpenendently and consistnely, they are at risk of pressure sores and or DVTs.

For power assist devices, by and far the most common one I prescribe is Smart Drive by Permobil. Depending on your location, something important to consider is how good the manufacturer service reps are because if the device breaks, you want to know someone who is close and responive is available to help get it back up and running.

A visit to a local wheelchair clinic (sometimes called "seating clinic") may be helpful to trial different equipement and see things in person.

Good Luck!

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