BeasyTrans© ETS Reimbursement Guide

The time it takes to produce the necessary information for effective BeasyTrans, ETS reimbursement will vary substantially for each client/patient and funding source. Effective reimbursement often requires not only time, but depends on the clarity and quality of a submitted application. By following the listed steps and using the proper BeasyTrans terminology described in this manual, you will be able to submit the most effective BeasyTrans application possible. The three most important things to remember when applying for reimbursement is:

• Establish a medical need for a BeasyTrans.
• Paint a clear patient/product specific picture of this need.
• Be persistent even if denied coverage at first.

Also remember to enclose all the materials required by that funding source. Listed below is an outline of the materials described in this manual you may want to use as part or in addition to any required information. By supplying the funding source with as much pertinent, supporting information as possible, you help to strengthen your chances of successful reimbursement.

Cut along this line & include this outline w/application.

Material Outline

1. Application for funding source
2. Document of Evaluation
3. Physician prescription (signed by a physician)
4. Letters of Medical Necessity
   
   • Include more than one if possible, other sources may include: doctors, other therapists, nurses, social workers, etc.
5. Funding Justification
6. Patient/Product supporting materials
   a. Pictures, testimonials, basic product literature (brochures, videos, etc.)

With the help of many medical professionals, vendors and end-users, we have been able to gather and organize effective reimbursement information.

The BeasyTrans is a relatively new and class distinctive product that has gained the support of insurance companies across the country. As it stands now, several insurance companies have assigned a direct code for its coverage but with many it must still be filed under a miscellaneous code.

Chances are good that a submitted application for a BeasyTrans under the miscellaneous code will be sent into review by the reimbursement source. By generating a proper and complete Beasy packet for the review committee we can eliminate the ambiguity of patient need and committee education.

Steps To Reimbursement

As a medical professional, vendor, or end user, there are a few steps to follow in receiving successful reimbursement for the BeasyTrans, Easy Transfer System. The following information has been gathered from several individuals who have received reimbursement from Medicare, Medicaid, private insurances and civic groups. Health care providers play an especially crucial role in the process for Beasy reimbursement. The following steps are a guide to submitting a complete BeasyTrans, ETS packet for reimbursement.

There are basically three steps to follow when applying for BeasyTrans reimbursement. Please keep in mind that this is not intended as a “How To” manual but is recommend to be used as a reference guide.

Step 1: Evaluation/Diagnosis

This is the most important process and documentation in the entire reimbursement request. The quality of the evaluation will drive the rest of the system. As important is the skill a medical professional uses to determine a patients needs as well as style and directness of the write up.

The evaluation should be completed, documented and signed by a therapist/physician.
The written evaluation should minimally include:

1. The background, history and diagnosis of the patient;
2. The current status of the client;
3. How the Beasy will improve the patient’s condition and why it is a medical necessity (please see the example letters in the second half of this guide).

Step 2: Documentation – Other than the Evaluation.

Regardless of the agency or funding source, it is imperative to have demonstrated and documented the need for a Beasy with a patient. Materials essential to documenting a patient’s need for a BeasyTrans:

- Physicians prescription
- Letter of medical necessity from a physician.

1. General discussion of medical diagnosis.
2. Discussion of Beasy specifications as it relates to the patient.
3. Explanation of the individual’s functional skills without the Beasy and how the Beasy will improve such skills.
4. You may also want to include any other transfer equipment that was evaluated for
   this patient and explain why the Beasy was the product you chose.
   - Letters of medical necessity from other medical professionals involved in the case.
   - Include product literature, brochures, video and other descriptive Beasy information.

Step 3: Develop a Funding Justification

This documentation is different than the evaluation write up. This useful documentation should be used to pre address the questions a funding source may ask. This is in addition to the evaluation and does not focus on establishing a need. Here you should explain why “they” should fund a BeasyTrans. The reimbursement justification should minimally include the following:

• What the exact needs are that will be alleviated by using a BeasyTrans.
• Individual’s proven and documented ability to use the Beasy effectively. Highlight
  specific areas, i.e., reduction of skin breakdown, independence, safety, etc.
• The rationale for the Beasy being the ONLY transfer equipment to successfully meet
  patient’s needs. Include other equipment that was evaluated but fell short.
  * Include any other relevant historical reimbursement practices concerning the Beasy
  and the institution being sought for reimbursement (i.e. previous coverage, cost
  effective). 
  * Include any available pictures or video of patient successfully using Beasy. Also
  include letters or comments from family members.

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Co-Payment Options

Some primary funding sources may not cover the Beasy in the full amount applied for. We have had good results when supplemental insurances or community-philanthropic organizations are approached to pay the difference. Many of these organizations will assist financially only after a client has been denied by other sources. Reimbursement from these sources is generally a case specific process requiring the same documentation presented to a patient’s primary coverage. You may also want to include a letter explaining the patient’s financial condition and reason for seeking extended reimbursement. Examples of such groups include: National Multiple Sclerosis, the ALS Association, Easter Seals, Churches, Lions, Elks, etc.

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Appeals Process

This is a very common process when it comes to seeking reimbursement for assistive technology. You are strongly encouraged to reapply for reimbursement if denied. Many resubmitted claims have been granted reimbursement after first being denied. Resubmitting a claim often tells a reimbursement source this is a necessary piece of equipment and not simply a convenience item. There is no penalty for resubmitting a claim for a Beasy. Questions you may want to ask before resubmitting the required paperwork are:* Did the request clearly address the patient needs for requiring a BeasyTrans?

* Was there a lack of understanding as to patient needs, equipment use, cost, etc?

* Was all the required information submitted? The reasons a Beasy may not be covered can sometimes be as simple as lack of understanding or knowledge of the reviewers at the funding source. Often if a letter is reworded, more supporting evidence is given (i.e., pictures, letters from other therapists or nurses) and the packet is resubmitted, the chances for Beasy reimbursement are greatly increased. You may even want to call the funding source and ask them what other information is necessary to receive coverage.
DO NOT simply re-submit the same documents and never give up until you get what you need!!!!!

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Knowledge is Power

By supplying product and patient information to reimbursement sources, you are helping to make the BeasyTrans available for future patients in need of this technology. “So if at first you don’t succeed, try, try again.” It will pay off.

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Insurance & Medicare Terminology

The use of proper terminology is critical for BeasyTrans reimbursement. When submitting a claim or writing a Letter of Medical Necessity for a patient, the proper tone and phraseology can mean the difference between a reimbursed or non reimbursed claim. Below are several phrases we have taken from letters of medical necessity that have helped result in BeasyTrans reimbursement. Each of these phrases have been selected to illustrate the general theme and tone of how other medical professionals have described their patients needs to require a BeasyTrans. You may want to incorporate these examples in your letter:

* This item is a medical necessity.

* The Beasy will restore patient to their best possible functional and independent level.

* The patient will require a Beasy indefinitely.

* The patient requires this Beasy to have continued access to outpatient medical care.

* The Beasy will allow this patient to remain at home with the help of an aid rather than having the need of a greater level of care in a nursing home.

* Having evaluated several other products, including: _____, the BeasyTrans best fit
this patient's transfer needs.

* The disk, not found on any other system, will protect this patient from shear forces
which may cause skin breakdown.

* When reviewing this product please consider this patient's safety.

* The rotating sliding disk allows the patient to be quickly and efficiently transferred with minimal assistance.

* The use of this equipment will allow the patient to function independently, improve the patient's functional ability and provide a safe environment for the patient.

* DO NOT refer to the Beasy as a "transfer board", but rather a "transfer system".

* DO NOT imply the Beasy is a "convenience", but rather a "medical necessity".Q: Is there a list of reimbursement companies?

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Mistakes to Avoid

DO NOT Refer to the Beasy as a “Transfer Board” instead describe it as a “Transfer System"
DO NOT Imply the Beasy is a “Convenience” item, it should explicitly be referred to as a medical necessity.”

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Important Topics for Documentation

Independence = INCREASED 
Home vs. Institutional Care = HOME
Continued Medical Care = INCREASED
(out patient/home care)
Reduction of Skin Breakdown = INCREASED
Cost Efficient = INCREASED
Patient Safety = INCREASED