WC funding Flashcards
Eligibility for medicare WC funding (#1 funder!)
65+ years old
at least 2 years w/ disability (MD determined)
indoor home mobility need
*rule is 5 years –> need a change in function, new Dx, and MD documentation to get a new one in under 5 years
*weight gain DOES NOT QUALIFY
If the WC was funded by another insurance, will medicare fix it?
NO, need to buy a new one via medicare
order of equipment: lower level need to higher level need
*must rule out lower to qualify for higher
- cane
- walker
- rollator
- scooter
- manual WC
- power WC
Eligibility for Medicaid WC
- can apply as soon as disabled
- income about 23,000$/year, $2000 or less in total resources, 1 car only (cannot make over 902$/month
FOR THOSE WHO ARE:
3. over 21 and homebound
4. or 21 and younger
4. pregnant
If patient has Medicare and Medicaid:
power WC is 23,000 and medicare agrees to pay 18,000. Medicaid will pay ____
remaining amount ($5000)
*follows medicare guidelines
if WC is warranted 2 years and the WC has problems at year 3, need _____
preauthorization for WC adjustments or repairs
Medicaid will pay rental while chair is being fixed for up to __ months
if longer needed, refer to seating clinic for complete seating eval for custom WC/seat
Medicare will pay up to ___ months
Medicaid: 6 months
Medicare: 12 months
If you have medicare, medicaid, or private insurance and a traumatic SCI/TBI you can qualify for ___ after exhausting all personal medical benefits 1st
For TBI/SCI caused by external physical force
comprehensive rehabilitation services TX
(but based on income, and budget varies every year)
person licensed to give recommendation for certain equipment
ATP (assisted technology practitioner)
In order to qualify for a medicare WC, you need a ___ and a _____MD evaluation
WC referral/order and face to face MD eval
To qualify for CRS, you must:
- have TBI/SCI caused by external TRAUMA affecting function at home or community
- at least 15 yrs
- US citizen or permanent resident/TX resident
- willing and medically stable for rehab participation
*pays for at least 30 days of inpatient
*pays for durable medical equipm
