A survival skill for complex rehab providers and therapists

Presenter: Gerry Dickerson, CRTS, Director of Rehab Technology, Medstar, Inc.

Different Types of No in the Rehab industry:

Corporate No (or not saying no). This is when saying no is out of your hands based on business decisions, practices, or insurance contracts.

• Managed Care contracts
• Making it up in volume
• Leveraging Complex Rehab (Loss leader to get a contract for different business)

Saying No in this instance may be out of your hands based on existing practices but it is also important to have the ability to say no in the future based on opportunities that arise. The caution here is to not use rehab business as a loss leader for gaining other business. This hurts the industry as a whole as well as hurting the consumer by reducing access to needed equipment as reimbursements are continually lowered.

Point of Service No (including items that aren't fundable)

• "Can you just grow my chair. . . "
• "It's just a simple repair. . . "
• Giving a product or service away for free
• Formularies

Our job is ". . .Providing the best available product match based on clinical indicators allowed under the payer source." Our job is not to give stuff away for free. Free service, upgrades, and products set unrealistic expectations with the therapists and the consumers.

New York state Medicaid Myth:
Gerry shared his experience with providing a TiLite K0009 Wheelchair in New York City to a customer with Medicaid. In New York, a provider can set up a private pay agreement with a consumer IF:

• both parties have agreed PRIOR to the rendering of the service that the enrolee is being seen as a private-pay patient
• signed consent
• NEVER bill Medicaid for that particular piece of equipment

The message is that we need to stop assuming that we can't bill a Medicaid beneficiary cash for items. We need to investigate the rules and laws that govern the benefit and take full advantage of all options available state to state.

Pushing Back
Just because you hear no from a payor source does not mean that the equipment can not be provided. Push back to the funding source and exhaust all avenues. Investigate alternate options. Don't forget cash. Use video to prove the medical necessity of the equipment needed by your clinic.

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