Funding a Stander

Therapist and/or Physician determine medical necessity for a standing program. Before initiating a standing program, medical clearance is critical for the consumer to stand. Clinical data, and a review of relative risks and benefits of use, determine medical necessity. This information is gathered through clinical assessment and should, at minimum, include the following:

• Consumer data
• Physical findings
• Measurement

Rehab Team determines the most appropriate standing device for the consumer. Using the assessment data and goals for the consumer, consider all standing device options and select the device that is the least costly, equally effective alternative.

• Therapist and Consumer schedule an appointment to trial the selected type of standing device. Involve a complex rehab technology supplier (and possibly manufacturer’s representative) to ensure appropriate set up of the trial equipment.
• Based on the results of the trial, determine the specific model of standing device required and necessary support and alignment options.
• Ensure the consumer/caregiver is able to successfully utilize the device and its features and will work in all intended environments.

Gather necessary documentation from the Rehab Team for product justification. Requests for authorization of standing devices are typically submitted by the CRT supplier and must be accompanied by clinical documentation from a licensed physician or occupational or physical therapist. The writer should establish their expert credentials by describing: expertise, licenses, education, current job title and years of experience at the beginning of the LMN. Documentation must support the medical necessity for this equipment.

 Payment decision is received from funding source.

• Approval: Payment approval is granted – the supplier will order the equipment and schedule delivery with the consumer and prescribing clinician.
• Denial: If faced with a denied claim, always appeal the decision.