PART 2: A roadmap to ordering your wheelchair

In Part 1 of this 3-part series, I introduced you to the people involved in your wheelchair order. Part 2 will describe the step-by-step process of your wheelchair order. From the two visits with your healthcare provider and seating specialist through the authorization by the payer (insurance), to delivery of your wheelchair, here is how we git ‘er dun! 

Let’s Face It!

During the “face-to-face mobility evaluation”, your healthcare provider (HCP) will collect information by asking you a bunch of questions and then doing an exam. You’ll be asked numerous questions about your environment, your functional abilities and your body.  Specific data will be collected, per Medicare guidelines. For example, you will have measurements such as your height and weight and your strength and range of motion. The HCP might check for the presence of spasticity, pressure ulcers, scoliosis, or arm injuries.  An experienced HCP knows what to document, and in how much detail for a particular type of wheelchair.  For example, an ultralight wheelchair order requires lots of details about the wheelchair-user’s daily life and activities, so your HCP should be asking you questions about those things and recording your answers in the medical health record. 

I cannot speak for other HCPs but if you were to see me for a face-to -face mobility evaluation, I would not be able to answer your questions about particular models of wheelchairs. Those questions should be directed to the wheelchair seating specialist, or you can do an internet- search for consumer reviews or industry ratings for particular wheelchair models. 

Did you know…

• Some larger rehabilitation institutions may offer a “Wheelchair Seating Clinic”, where several wheelchair specialists, including a Physical Medicine and Rehabilitation doctor, participate in the evaluation.

• Medicaid reimburses for wheelchair seating evaluations in some states, but not in others. An example: in California Medi-Cal does NOT reimburse for an OT seating evaluation. 

• Medicare DOES reimburse for 80% of an OT seating evaluation. Secondary insurance or supplemental funds are usually used to pay for the remaining 20%

• If insurance does not cover a feature like a seat elevator, you can pay out of pocket for just that feature on your wheelchair.

Under Pressure

What about seat cushion “pressure mapping”- where you sit on a pressure-sensing pad that generates a color-coded “map” of the pressures your bottom creates in sitting- do you absolutely need to have that done? According to Norma Stadler, OT Seating Specialist at Alta Bates Summit Medical Center in Berkeley: “Pressure-mapping is appropriate when you have a chronic or recurring wound on your butt”. Does Norma use a pressure mapping device during her wheelchair seating evaluations? No, she says, but vendors NuMotion and National Seating and Mobility both provide pressure mapping and can be looped in. Choosing the right seat cushion for your size, shape, ability to relieve pressure and integrity of skin is of utmost importance, and will be addressed during your visit with the wheelchair seating specialist. 

During your visit with the wheelchair seating specialist (OT, PT, ATP), you can expect a detailed history and examination that goes deeper into the intersection between your body and the piece of equipment you need. Measurements of your back, arms and legs will be taken, as well as precise measurements of your range of motion and fine and gross motor function. 

The Devil is in the Details

• You may wish to have a discussion with the seating specialist about rear- vs. mid- vs front- wheel power drive technology, and why you might prefer one or another. 

• The drive feature- joystick, other hand control or head array- will be considered. 

• Back rest, trunk support and seat cushion

• Features that will or will not allow an independent car transfer

Do!

• Bring your support person to the seating evaluation to take notes

• Make sure you have the name and telephone number of the DME vendor before you leave from the mobility and seating evaluation 

• Before you leave Acute Rehab, make sure you have the contact info for the DME vendor and find out how to return a loaner wheelchair

Mobility and Seating Evaluations while in Acute Rehab

If your mobility and seating evaluation is being done while in Acute Rehab, the seating specialist (OT or PT) will use your allotted therapy time to complete the evaluation.  Dear reader, if you are reading this while admitted to Acute Rehab, please understand this is an important evaluation, and give this session your utmost attention! Make sure your nurse is aware of the upcoming seating evaluation at least by the night before. Make a plan so you aren’t late to this!

The Squeaky Wheel Gets the Grease

After you’ve had these two separate evaluations, your seating specialist transmits their specific recommendations to the DME Vendor and, within 45 days per Medicare guidelines, your healthcare provider also submits their documentation from the face-to-face mobility evaluation to the DME vendor. 

This is where having the phone number for the DME Vendor comes in.  I recommend you call the DME vendor about 30 days after your seating evaluation and ask if the progress notes (healthcare record) from each of these visits has been provided to the vendor. If the vendor tells you it has not, call both the HCP and the seating specialist and tell them that it needs to be checked on. Then, a few days later, call the DME vendor and ask again if they received all the documents. Repeat this process until the DME vendor says all the documentation is submitted and complete.

Once the DME vendor has the required documentation for your wheelchair order, which includes the completed signed progress notes from two healthcare visits, they then submit a request for authorization to the payer (insurance).  The time it takes for an authorization approval or denial from Medicare is 30 days after all of the required elements of the order are submitted. Private insurance typically follows this same time frame for a decision. When the authorization is approved, the wheelchair manufacturer can now start to put together your wheelchair! Hooray!

Next up...

So, what can go wrong and either create a long delay, or worse, result in you getting a wheelchair you can’t stand? Stay tuned for Part 3: pitfalls you want to avoid, and tips and resources for getting the very best wheelchair and then keeping your wheelchair in great shape. 

Rebecca Hummel-Moore, MSN, NP-C is a nurse practitioner and Advisory Board member for NorCal SCI. She practices in Berkeley, CA and has 12+ years working with people with SCI/D in both inpatient and outpatient settings.