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U.S. Rehab is the nation’s largest network of independently owned rehab technology providers.
The VGM Group, Inc., company has more than
360 members in more than 1,100 locations throughout the U.S.
Members whose service technicians have been trained and tested by U.S. Rehab vendors make up the Red, White & Blue Certified Repair Network.
The certifications ensure that patients and payer sources receive the best service available for their mobility equipment needs.
As technology evolves, servicing and repairing rehab equipment becomes more challenging. Our
Standardized Rate Guide was developed so service providers have guidelines about fair and adequate compensation levels, ensuring an accurate and consistent basis for the billing and reimbursement of repair services.
Red, White, Blue Certified Repair Network
Standardized Repair and Service Guide
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
How to use this guide . . . . . . . . . . . . . . . . . . . . . . . 4
Repair questionnaire . . . . . . . . . . . . . . . . . . . . . . . . 5
Standardized Labor Rate Tables:
Standard Manual Chair
Folding and Rigid Frame . . . . . . . . . . . . . . . 6-11
Scooters . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-17
Power Wheelchair
Gearbox/Direct Driven/Belt Drive . . . . . . . 18-26
KO462 Billing for loaner equipment . . . . . . . . . . . 27
Pointers on repairs . . . . . . . . . . . . . . . . . . . . . . . . 28
Updates to labor payment rates . . . . . . . . . . . . . . . 29
Repair labor billing and payment policy . . . . . . . . . 30
Payment for delivery and service charges for durable medical equipment . . . . . . . . . . . . 31-32
Repair shop pointers . . . . . . . . . . . . . . . . . . . . 33-34
Steps to easy power wheelchair maintenance . 35-36
Steps to easy manual wheelchair maintenance 37-38
Job Classification Section . . . . . . . . . . . . . . . . 39-58
U .S . Rehab Exclusive Vendors . . . . . . . . . . . . . . . . . 59
Copyright 2012 U.S. Rehab ®
Multiple uses for this guide
1. Give to service managers so they have a way to document time spent on standard
service and repairs for most manual and power wheelchairs. Tools are provided to set
up your workflow on computer.
2. Tracking repair time and processes is very helpful when discussing and negotiating
reimbursement issues with payer sources.
3. The guide considers all major brands and models, individual technologies and
combines their service recommendations into a piece that is accurate and credible.
Advancements in rehab technology have occurred rapidly, and more are coming. The Red, White & Blue Certified Technician Program was developed to provide member companies and service technicians with the education and skills necessary to work efficiently and professionally. However, education and skill are not enough to be successful in business. Billing and reimbursement are a daily concern.
This rate guide was a collaborative effort among U.S. Rehab staff, our manufacturers and service providers at U.S. Rehab Member companies. We consider it a “living document” that will be updated as necessary.
The time allowances in this guide are based on federally mandated operating criteria and take into consideration the repair center’s adherence to strict quality standards.
1. Site is fully accredited.
2. There is a certified technician on staff.
3. A continuing education program keeps staff current on job skills.
4. A fully operational service/repair shop has appropriate equipment, both
diagnostic and mechanical tools, any specialized tools, fixtures or jigs as specified
by manufacturers, and adequate floor and bench space with proper ventilation
and lighting.
5. There is a designated area to clean dirty/contaminated equipment. Refer to ACO
Quality Assurance Requirements.
6. There is ample storage for equipment staged for service.
7. An established set of policies and procedures for the safe handling and disposal
of hazardous materials (batteries, solvents, circuit boards, cleaning materials)
exists, and complies with EPA, local ordinances and respective MSDS sheets.
8. An adequate inventory of parts for standard repairs is kept.
9. Accurate and current repair and service records allow equipment to be tracked in
case of a product recall or safety update.
10. All repairs are made according to manufacturer standards. Service manuals, technical publications, parts catalogs and service bulletin are kept on file for reference.
11. If billing Medicare for complex rehab, technicians must earn required continuing education units annually.
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4
1. Each section is broken down by category.
2. For standardization purposes, the repair time estimates
have been converted from minutes to decimals in tenths
and quarters of an hour. This allows the service manager
to quote individual repairs in comparison or in addition
to minimum labor charges.
Minutes Decimals
6 0.10
15 ¼ Hour 0.25
30 ½ Hour 0.50
45 ¾ Hour 0.75
3. These estimated repairs do not include cleaning,
abnormal rust, corrosion or damaged equipment that
requires extra time. It is recommended that additional
time be billed for those tasks.
60 1 Hour 1.00
4. Pickup and delivery are not included in these
suggested times. Follow company billing procedure
for these services.
5. Initial troubleshooting and repair diagnostics are
included in these standard rates and times. Additional
or advanced diagnostics should be charged as
additional time.
Working with standardized rates requires certain procedures to be standard policy .
The following are true for service and repair of all mobility equipment:
Medicare doesn’t reimburse for pickup and delivery of repairable items, so you can’t bill a patient for this service. These are additional charges and are billed according to your company’s policy for other insurance carriers.
All equipment should be cleaned, disinfected, tagged and the required service documented before the piece enters the service area. It is recommended 1.0 hour be added for cleaning and disinfecting.
Custom fabrication or complex repairs are not in the standard rate tables and should be billing accordingly.
A minimum labor charge should be applied to all repairs; do not waive it because a repair is small and didn’t take much time.
The tables and forms in this guide may be copied.
See attached CD on the back of the booklet.
Patient Name __________________________________________________________
Medicare No. __________________________________________________________
Address _______________________________________________________________
Name, Make and Model of the item that is being repaired:
_______________________________________________________________________________
Serial number of item being repaired:
_______________________________________________________________________________
Date wheelchair (item) was provided: ____________________________________
How was wheelchair (item) funded? (payer source): ________________________
If funded by Medicare was chair (item) purchased or rented? ________________
If the wheelchair (item) was provided by a company other than _________________________ the information above must be confirmed by the supplier (if the supplier is unknown to the patient or out of business do a three way call to Medicare and get correct information.)
Confirmed by: ____________________ (employee)
Date: ____________________
You must make sure that your staff document what exactly was done and break out in increments of 15 minutes time for each item repaired/replaced i.e.- changed rt arm pad ____ minutes /replaced rt tire _____ minutes etc.
USREH-R001
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6
Standardized Repair and Service Rate Tables:
–
Date Provided: ____________
Client Name:____________________________________________________________________________
Manufacturer: _________________________ Model #: ______________ Serial #: _____________
Nature of Problem: ______________________________________________________________________
Loaner Chair received:
Yes: _____ No: _____ Name: ________________ Make: _____________ Model: _______________
Serial #: ________________________
(01) Wheels, Tires, Forks
Part
Number
Billing Code
Tire and/or tube replacement, includes wheel remove/replace
Replace pneumatic tire and/or tube
(per wheel)
Replace pneumatic tire with airless insert
(per wheel)
Replace solid snap-on tire (per wheel)
E2211 tire
E2212 tube
E2211 tire
E2213 airless insert
E2220
Time # Units
Rear wheels
Replace wheel assembly (each)
Spoked wheels: true rim & replace spokes as noted:
No spokes required
1-5 spokes required (additional time)
6 or more spokes required
(additional time)
Replace quick release axle (each)
Replace threaded axle (each)
Replace and adjust bearings, per wheel
(each)
Adjust bearing play only, per wheel
Adjust camber
Replace camber sockets/brackets (pair)
Handrims (per wheel)
Replace handrim only
Replace threaded inserts
K0069 solid tire
K0070 pneumatic tire
K0108
K0108
K0108
K0108
K0108
K0108
E2210
K0739
K0739
K0108
E2205
E2205
K0108
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8
Casters and forks
Replace caster/fork assembly (each) E2226
Replace stem bearings, adjust (per fork)
Remove stem bearings, lube and adjust
(per fork)
Replace caster wheel (each)
E2210
K0739
E2225
Replace caster wheel **, bearings, adjust
(per wheel)
**
K0071 Front caster comp pneumatic tire
K0072 Front caster comp semi-pneumatic tire
K0073 Caster pin lock each
K0077 Front caster assembly complete
E2214 Pneumatic caster tire each
E2215 Pneumatic caster tire tube
E2210
E2217 Foam filled caster tire each
E2219 Foam caster tire any size each
E2221 Solid caster tire each
E2222 Solid caster integrated wheel
E2225 Caster wheel excludes tire
E2384 Pneumatic caster tire
Wheel lock replacement and adjustment
Toggle lock (each)
Toggle locks with grade aid (each)
Lever locks (all types) (each)
Replace wheelchair brake extension
Replace caster wheel **, bearings, adjust
(per wheel)
Section Total
Wheel locks, adjust only
Toggle locks (both)
Toggle locks with grade aid (both)
Lever locks (all types) (both)
Replace wheelchair brake extension
Replace caster wheel **, bearings, adjust
(per wheel)
Section Total
Part
Number
(02) Armrests
Replace armrest latch or lock (each)
Replace armrest pad (each)
Replace armrest sidepanel, screw type
(each)
Replace armrest sidepanel, pop rivet type
(each)
Replace detach non-adjust height armrest
Replace detach adjust armrest base
E2206
K0108
E2206
E0961
E2210
E2206
K0108
E2206
E0961
E2210
Billing Code
K0108
K0019
K0108
K0108
K0015
K0017
E2385 Tube, pneumatic caster tire
E2387 Foam filled caster tire
E2391 Solid caster tire
E2392 Solid caster tire, integrate
E2395 Caster wheel excludes tire
E2396 Caster fork
Time # Units
(02) Armrests
Replace detach adjust armrest upper
Replace arm pad (each)
Replace fixed adjust armrest pair
Replace access detach adjust armrest
Replace standard wheelchair armrest
Replace wheelchair fixed full length arms
Replace wheelchair detachable arms
Section Total
Part
Number
(03) Legrests and Footrests
Replace elevating legrest assembly, nonpowered (each)
Replace adjust angle footplate (each)
Replace large size footplate (each)
Replace standard size footplate each
Replace footrest lower extension tube
Replace footrest upper hanger bracket
Replace footrest complete assembly
Replace elevate legrest low extension
Replace elevate legrest up hanger bracket
Replace swingaway detach footrest
Replace elevate footrest articulate
Replace loop heel
Replace toe loop/holder (each)
Replace wheelchair No . 2 footplates
Swinging and detachable cam or latch block device
Section Total
(04) Backs
Back upholstery
Replace standard back sling upholstery
ADD for adjustable tension sling
ADD to replace broken screw in back post (requires drilling)
Part
Number
Part
Number
Billing Code
K0018
K0019
K0020
E0973
E0994
E1050
E1060
Billing Code
E0990
K0047
K0052
K0053
E0951
E0952
E0970
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0108
Billing Code
E0982
E0982
K0108
K0108
Time
Time
Time
# Units
# Units
# Units
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10
(04) Backs
Replace solid back insert
Back posts, manual
Non-folding, one post
Non-folding, both posts
Folding, one post
Folding, both posts
Replace push handle grips (pair)
Section Total
(05) Seats
(standard sling or basic insert)
Replace seat upholstery
Solid seat insert
Section Total
(06) Frames and
Related - Folding
Complete disassembly and assembly
Replace sideframes (single or pair)
Replace crossbars (single or pair)
Replace crossbar inner rail (per side)
Replace seat rail guide tips/slides
(per side)
Replace front post telescopic slides
(per side)
Section Total
(07) Frames and Related - Rigid
Complete disassembly and assembly
Section Total
Part
Number
Part
Number
Part
Number
Part
Number
Billing Code
E0992
K0108
K0108
K0108
K0108
K0108
K0108
Billing Code
E0981
E0992
Billing Code
K0739
K0108
K0108
K0108
K0108
K0108
Billing Code
K0739
Time
Time
Time
Time
# Units
# Units
# Units
# Units
(08) Miscellaneous and General Services
Replace all plastic/rubber parts (less tires)
Replace and glue on post grips
Complete cleaning and disinfecting per
OSHA (with no rust or corrosion)
Remove broken/stripped screw (drill and tap) add to job time
Remove broken/stripped bolt (drill and tap) add to job time
Section Total
Section 1 Total
Section 2 Total
Section 3 Total
Section 4 Total
Section 5 Total
Section 6 Total
Section 7 Total
Section 8 Total
Grand Total
Part
Number
Billing Code
K0108
K0108
K0739
K0739
K0739
Time # Units
USREH-MC001
*Billing codes are subject to change make sure updates are followed as of date published by Medicare.
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Standardized Repair and Service Rate Tables:
Date Provided: ____________
Client Name:____________________________________________________________________________
Manufacturer: _________________________ Model #: ______________ Serial #: _____________
Nature of Problem: ______________________________________________________________________
Loaner Chair received:
Yes: _____ No: _____ Name: ________________ Make: _____________ Model: _______________
Serial #: ________________________
(01) Batteries and Cables
Replace batteries
Check and clean terminals, charge and match voltages within 0 .2 volts, clean battery boxes of dirt and electrolyte per all OSHA hazardous material handling procedures, and dispose of old batteries per EPA and local ordinances .
DOES NOT INCLUDE TESTING
Check and clean terminals, charge and match voltages within 0 .2 volts, clean battery boxes of dirt and electrolyte per all OSHA hazardous material handling procedures, and dispose of old batteries per EPA and local ordinances .
INCLUDES TESTING
Testing and diagnosis
Check for voltage at charger port .
Check for voltage at battery terminals of individual batteries and compare results .
Part
Number
Billing Code
K0739
K0739
K0739
Time # Units
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14
Cables and connectors
Clean battery terminals only
Replace battery cable/harness
Replace tiller to controller cable
Repair/clean connectors
Replace contact(s) in connector:
Replace 1 contact
Add for each additional contact
Replace multi-pin connector assembly
Section Total
K0739
K0108
K0108
K0739
K0108
K0108
K0108
K0108
(02) Motors
Part
Number
Billing Code Time
Replace power wheelchair motor replacement only
Replace wheelchair gear box only
E2368
E2369
Replace power wheelchair motor/gear box combo
E2370
Inspection of brushes: check length, wear pattern and spring for evidence of excessive heat
1 motor K0739
Both motors
Replace brushes, inspect commutator, seat brushes:
K0739
1 motor
Both motors
Section Total
K0108
K0108
Part
Number
Time (03) Drive Train Belt/Chain
Belt tension adjustment
Chain tension adjustment
Belt replacement
Chain replacement
Section Total
Billing Code
K0739
K0739
K0108
K0108
# Units
# Units
(04) Electronics
Replace power module
(ADD programming if required):
Program power module (basic parameters)
Replace tiller components:
Replace throttle potentiometer, calibrate (includes tiller removal/replacement)
ADD: solder if required
Replace tiller board
Part
Number
Billing Code
K0108
K0739
K0108
K0108
K0739
K0108
Per item below, not to exceed .5 hour for any multiple
Replace battery meter
Replace headlight
Replace headlight switch
Replace speed potentiometer
Replace key switch
Replace 1 contact
Section Total
K0108
A9270
A9270
K0108
K0108
K0108
Part
Number
(05) Battery Chargers
Test charger output
Replace fuse
Replace on-board charger
Section Total
Billing Code
K0739
K0108
K0108
(06) Frames and Shrouds
Replace frame base
Part
Number
Billing Code
K0108
Replace tiller assembly
Quick release (no tools required)
Bolt-on tiller
K0108
K0108
Time
Time
Time
# Units
# Units
# Units
15
16
Replace shroud (each)
Tiller shroud
Base shroud
Section Total
(07) Wheels and Tires
Part
Number
Replace drive wheel assembly (each)
Replace foam filled drive wheel tire each
Replace foam drive wheel tire each
Replace drive wheel excludes tire each
Replace pneumatic drive wheel tire
Replace tube, pneumatic wheel drive tire
Replace pneumatic caster tire
K0108
K0108
Billing Code
E2386
E2388
E2394
E2381
E2382
E2383
Tires/tubes (per wheel)
Replace pneumatic tire and/or tube
Replace pneumatic tire with airless insert and split rim
Section Total
(08) Armrests
Replace armrest latch or lock (each)
Replace armrest pad (each)
Replace armrest sidepanel, screw type (each)
Replace armrest sidepanel, pop rivet type (each)
Replace detach non-adjust height armrest
Replace detach adjust armrest base
Replace detach adjust armrest upper
Replace arm pad (each)
E2211 tire
E2212 tube
E2211 tire
E2213 airless insert
Part
Number
Billing Code
K0108
K0019
K0108
K0108
K0015
K0017
K0018
K0019
Time
Time
# Units
# Units
(08) Armrests
Replace fixed adjust armrest pair
Replace access detachable adjust armrest
Replace standard wheelchair armrest
Replace wheelchair fixed full length arms
Replace wheelchair detachable arms
Section Total
Part
Number
Billing Code
K0020
E0973
E0994
E1050
E1060
(09) Seats and Backs
Replace seat assembly, captain or van type
Replace rehab seat
Replace folding back
Section Total
Part
Number
Billing Code
K0108
K0108
K0108
(10) Miscellaneous and General Services
Part
Number
Complete cleaning and disinfecting per OSHA
Billing Code
With no rust or corrosion
Minor rust or corrosion
Remove broken/stripped screw (drill and tap) add to job time
Remove broken/stripped bolt (drill and tap) add to job time
Section Total
K0739
K0739
K0739
K0739
Section 1 Total
Section 2 Total
Section 3 Total
Section 4 Total
Section 5 Total
Section 6 Total
Section 7 Total
Section 8 Total
Section 9 Total
Section 10 Total
Grand Total
Time
Time
Time
# Units
# Units
# Units
USREH-SC001
*Billing codes are subject to change make sure updates are followed as of date published by Medicare.
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Standardized Repair and Service Rate Tables:
–
Date Provided: ____________
Client Name:____________________________________________________________________________
Manufacturer: _________________________ Model #: ______________ Serial #: _____________
Nature of Problem: ______________________________________________________________________
Loaner Chair received:
Yes: _____ No: _____ Name: ________________ Make: _____________ Model: _______________
Serial #: ________________________
Part
Number
Billing Code Time # Units (01) Batteries, Cables
Replace batteries
Check & clean terminals, charge and match voltages within 0 .2 volts, clean battery boxes of dirt and electrolyte per all OSHA hazardous material handling procedures, and dispose of old batteries per EPA and local ordinances .
DOES NOT INCLUDE TESTING
Check & clean terminals, charge and match voltages within 0 .2 volts, clean battery boxes of dirt and electrolyte per all OSHA hazardous material handling procedures, and dispose of old batteries per EPA and local ordinances .
INCLUDES TESTING
Testing and diagnosis
Check for voltage at charger port .
Check for voltage at battery terminals of individual batteries and compare results .
Load test batteries (in series)
Voltage and load test (both as above)
Test for voltage drop under load
K0739
K0739
K0739
K0739
K0739
K0739
K0739
Cables and connectors
Clean battery terminals only
Replace battery cable/harness
Replace wire harness
Replace contact(s) in connector
K0739
K0108
K0108
K0108
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20
Cables and connectors
Replace 1 contact
ADD for each additional contact
Replace multi-pin connector assembly
Section Total
K0108
K0108
K0108
(02) Motors
Part
Number
Billing Code Time
Replace power wheelchair motor replacement only
Replace wheelchair gear box only
E2368
E2369
Replace power wheelchair motor/gear box combo
E2370
Inspection of brushes: check length, wear pattern and spring for evidence of excessive heat
1 motor K0739
K0739 Both motors
Replace brushes, inspect commutator, seat brushes:
1 motor
Both motors
K0108
K0108
2-pole motors only
Inspection of brushes: check length, wear pattern and spring for evidence of excessive heat
1 motor
Both motors
K0739
K0739
K0739
K0739
Replace brushes, inspect commutator, seat brushes:
1 motor
Both motors
K0108
K0108
4-pole motors only
Inspection of brushes: check length, wear pattern and spring for evidence of excessive heat
1 motor
Both motors
K0739
K0739
Replace brushes, inspect commutator, seat brushes:
1 motor
Both motors
K0108
K0108
# Units
Test motors for current draw (amps)
1 motor
Both motors
Section Total
Part
Number
(03) Electronics
Replace hand/head control
Electro connect btw control
Electro connect btw 2 sys
Mini-prop remote joystick
Power wheelchair harness, expand control
Hand interface joystick
Multi-mechanism switches
Special joystick handle
Chin cup interface
Sip and puff interface
Breath tube kit for sip & puff interface
Head control interface mechanism
Head/extremity control interface
Head control nonproportional
Head control proximity switch
Attendant control
K0739
K0739
Billing Code
E2324
E2325
E2326
E2327
E2328
E2329
E2330
E2331
E2310
E2311
E2312
E2313
E2321
E2322
E2323
Time # Units
Programming (basic, initial settings): **CAN BE PART LABOR CODE WHEN DOING REPAIRS
Integral power module/joystick
Power module with standard remote joystick
Power module with specialty controls
Section Total
K0739 **
K0739 **
K0739 **
21
22
(04) Battery Chargers
Test charger output
Replace fuse
Replace on-board charger
Section Total
Part
Number
(05) Frames,
Shrouds, Crossbraces
Replace frame base
Without power tilt and/or recline
With power tilt and/or recline
Replace cowling/shroud (each)
Replace sideframe, belt driven
Right or left side only
Both sides
Replace cross braces
Without power tilt and/or recline
With power tilt and/or recline
Replace crossbar inner rail (per side)
Replace seat rail guide tips/slides (per side)
Standard arm models
Detachable arm models
Replace front post telescopic slides (per slide)
Standard arm models with detachable arms
Reclining back models
Section Total
Part
Number
(06) Wheels and Tires
Part
Number
Replace drive wheel assembly (each)
Replace foam filled drive wheel tire each
Replace foam drive wheel tire each
Replace drive wheel excludes tire each
Billing Code
K0739
K0108
K0108
Billing Code
K0108
K0108
K0108
K0108
K0108
K0108
K0108
K0108
K0108
K0108
K0108
K0108
Billing Code
E2386
E2388
E2394
Time
Time
Time
# Units
# Units
# Units
(06) Wheels and Tires
Replace pneumatic drive wheel tire
Replace tube, pneumatic wheel drive tire
Replace pneumatic caster tire
Part
Number
Billing Code
E2381
E2382
E2383
Casters and forks
Replace caster fork assembly (each)
Replace stem bearings and adjust
(per fork)
Replace caster wheel (each)
Replace caster wheel bearings and adjust
(per caster)
Section Total
E2226
E2210
E2225
E2210
(07) Armrests
Replace armrest latch or lock (each)
Replace armrest pad (each)
Replace armrest sidepanel (each)
Wheelchair access detach adjust armrest
Detach non-adjust height armrest
Detach adjust armrest base
Detach adjust armrest upper
Fixed adjust armrest pair
Section Total
Part
Number
Billing Code
K0108
K0019
K0108
E0973
K0015
K0017
K0018
K0020
(08) Legrests and Footrests
Replace elevating legrest assembly, non-powered (each)
Replace adjust angle footplate (each)
Replace large size footplate (each)
Replace standard size footplate each
Replace footrest lower extension tube
Replace footrest upper hanger bracket
Replace footrest complete assembly
Replace elevate legrest low extension
Replace elevate legrest up hanger bracket
Part
Number
Billing Code
E0990
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0047
Time
Time
Time
# Units
# Units
# Units
23
24
(08) Legrests and Footrests
Replace swingaway detach footrest
Replace elevate footrest articulate
Replace loop heel
Replace toe loop/holder (each)
Replace Wheelchair No . 2 footplates
Swinging and detachable cam or latch block device
Part
Number
Billing Code
K0052
K0053
E0951
E0952
E0970
K0108
Adjustment only, legrest/footrest (per side)
Extension of footplate assembly
Swinging and detachable cam or pin lock device
Section Total
Part
Number
(09) Backs
Back upholstery
Replace standard back sling upholstery
ADD for adjustable tension sling
ADD to replace broken screw in back post
(requiring drilling)
Replace solid back insert
K0739
K0739
Billing Code
E0982
K0108
K0108
E0992
Back Posts, manual
Non-folding, one post
Non-folding, both posts
Folding, one post
Folding, both posts
Powered backs
Replace 1 back post
Replace both back posts or back frame assembly
Replace actuator
K0108
K0108
K0108
K0108
K0108
K0108
K0108
Time
Time
# Units
# Units
Replace push handle grips (pair)
(See Section 11, Seating Systems (reclining back)
Section Total
(10) Seats
(standard sling or basic insert)
Replace seat upholstery
Replace van or captain type seat
Section Total
(11) Seating Systems
Tilt only (powered)
Replace tilt seating system assembly
Replace/repair actuator cable only
Part
Number
Part
Number
K0108
Billing Code
E0981
K0108
Billing Code
E1002
K0108
Reclining back, powered
Replace power seat tilt
Replace power seat recline
Replace power seat recline mechanism
Replace actuator (check alignment, travel stops, any evidence of binding, includes labor to replace cable if required)
Replace shear actuator
Replace/repair actuator cable only
Tilt with recline (powered)
Replace power seat combo without shear
Replace power seat combo with shear
Replace power seat combo power shear
Replace actuator (check alignment, travel stops, any evidence of binding, includes labor to replace cable if required)
Replace/repair actuator cable only (each)
Powered legrest
Replace elevating legrest (each)
E1002
E1003
E1004
K0108
K0108
K0108
E1006
E1007
E1008
K0108
K0108
E1010
Time
Time
# Units
# Units
25
Replace actuator (check alignment, travel stops, any evidence of binding, includes labor to replace cable if required)
Replace/repair actuator cable only (each)
Replace lateral trunk supports (each)
Replace headrest assembly
Replace headrest pad
Replace head rest extension
Section Total
(12) Miscellaneous and General Services
Replace all plastic/rubber parts (less tires)
Replace and glue on post grips
K0108
K0108
K0956
K0108
E0955
E0966
Part
Number
Billing Code
K0108
K0108
Complete cleaning and disinfecting per OSHA
With no rust or corrosion
Minor rust or corrosion
ADD for removal broken/stripped screw
(drill and tap)
ADD for removal broken/stripped bolt
(drill and tap)
Section Total
Section 1 Total
Section 2 Total
Section 3 Total
Section 4 Total
Section 5 Total
Section 6 Total
Section 7 Total
Section 8 Total
Section 9 Total
Section 10 Total
Section 11 Total
Section 12 Total
Grand Total
K0739
K0739
K0739
K0739
Time # Units
26
USREH-PW001
*Billing codes are subject to change make sure updates are followed as of date published by Medicare.
Medicare pays up to one month rental for loaner equipment while patient- OWNED equipment is being repaired .
1 . No modifiers required
2 . Narrative needs to state “loaner K0823 while patient-owned equipment is being
repaired took greater than one day to repair because parts on order”
{loanK0823ptondK0823took>1dpartsordered}
3 . This code can be used when any item is being repaired that the patient
owns (CPAP/BiPAP/Hospital bed/Hoyer lift/Manual W/C/any DME item as long
as it is not on rental)
4 . Repair and Maintenance
5 . CMS Manual System, Pub . 100-2, Medicare Benefit Policy Manual,
Chapter 15, §§110 .2 & 110 .4
6 . Under the circumstances specified in the Medicare Benefit Policy Manual,
payment may be made for repair, maintenance, replacement, and delivery of
medically required DME that the beneficiary owns or is purchasing, including
equipment that had been in use before the user enrolled in Part B of the
Medicare program . In addition, payments for repair and maintenance may not
include payment for parts and labor covered under a manufacturer’s or
supplier’s warranty .
The K0462 does not have to be on same claim but it is always best to do so .
K0739, the labor code, should be billed on first line with a narrative breakdown of the units of labor .
K0462 would be billed on the second line with a narrative of item description .
Then the parts would be billed with proper modifiers and units .
Example: E0955NURBKX 1
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Repairs for patient-owned equipment are covered if the item is still a medical necessity under
Medicare guidelines . There are many power wheelchairs out there that were never medically necessary under Medicare guidelines, so be sure you have documentation for both initial and continued need .
1 . Establish primary insurance .
2 . Establish who paid for the item (wheelchair, concentrator, nebulizer
or any type of DME)
3 . If paid for by Medicare is the item still (was it) medically necessary?
4 . If the wheelchair or other item was provided by a company other than yours,
you should verify all information, including the code billed .
5 . Make sure you have documentation of medical necessity on file before billing .
6 . Make sure you know that the item was a purchase and not a rental . Even
though items are now capped at 13 months, there could still be some items
remaining on maintenance and service .
Here is how you bill:
K0739 – 1 unit equals 15 minutes -- Labor code
K0462 – This is the code to use for the loaner equipment that you give the patient while their equipment is being repaired . Medicare will pay for up to one-month rental for a loaner chair
(or other item) while patient-owned equipment is being repaired .
Bill the proper code for the item being replaced with proper modifiers .
Example: E0973NURTRB for replacement (repair) of right armrest .
If no code, then bill the miscellaneous code (K0108) for wheelchairs and POVs .
If an item is being billed under the E1399/K0108, or any miscellaneous code, the same information is needed: Name, make, model and MSRP of item being replaced and documentation of the base item and statement that patient continues to need .
Documentation needed: (continued need from medical records)
1 . The first statement needs to be that this is repair for patient-owned Name_______
Make_______ Model #__________ purchased by __________ in 00/00/0000 . Patient (use first name) is a quad and requires a power wheelchair for all mobility .
2 . K0108 code needs the name, make, model and MSRP and why it is still medically necessary . Example: K0108 replacement _______ by Name _______ Make ________ Model #
__________ MSRP is $200 .
*
Go to http://www .palmettogba .com/ for current updates and other references .
*Please verify labor rates for your state prior to billing .
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Effective for dates of service on or after April 1, 2009, the Durable Medical Equipment
Medicare Administrative Contractors (DME MACs) are instituting a billing and payment policy for common repairs based on standardized labor times . This applies to non-rented and out-ofwarranty items . This effective date coincides with the effective date of the new code for repairs for non-oxygen equipment - K0739 (REPAIR OR NONROUTINE SERVICE FOR DURABLE
MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN,
LABOR COMPONENT, PER 15 MINUTES) . One unit of service = 15 minutes . Code E1340 is no longer valid for repairs for dates of service on or after April 1, 2009 .
The following table contains repair units of service allowances for commonly repaired items .
Units of service include basic troubleshooting and problem diagnosis . Suppliers are reminded that there is no Medicare payment for travel time or equipment pickup and/or delivery .
Type of Equipment
Power Wheelchair
Power Wheelchair
Power Wheelchair
Power Wheelchair
Power or Manual Wheelchair
Power or Manual Wheelchair
Power Wheelchair
Manual Wheelchair
Hospital Bed
Hospital Bed
CPAP
Seat Lift
Seat Lift
Patient Lift
Part Being Repaired/
Replaced
Batteries
(includes cleaning and testing)
Joystick (includes programming)
Charger
Drive wheel motors (single/pair)
Wheel/Tire
(all types, per wheel)
Armrest or armpad
Shroud/cowling
Anti-tipping device
Pendant
Headboard/footboard
Blower Assembly
Hand Control
Scissor mechanism
Hydraulic Pump
Allowed Units of Service
(USO)
2
2
2
2/3
1
2
3
2
2
2
1
2
1
2
Suppliers may only bill the allowable units of service listed in the above table for each repair, regardless of the actual repair time . Claims for repairs must include narrative information itemizing each repair and the time taken for each repair . Suppliers are also reminded that Medicare does not pay for repairs to capped rental items during the rental period or items under warranty .
Remember to bill your actual units. If a denial or audit is received it can be appealed.
Make sure your staff documents all repairs in case of audit.
Posted on 2/25/09
______________________________________________________
Keeping accurate records for your time spent on reports allows for cost tracking in your repair shop . All jobs should be costed .
(Rev. 1, 10-01-03) B3-5105
Delivery and service are an integral part of oxygen and durable medical equipment (DME) suppliers’ costs of doing business . Such costs are ordinarily assumed to have been taken into account by suppliers (along with all other overhead expenses) in setting the prices they charge for covered items and services . As such, these costs have already been accounted for in the calculation of the fee schedules . Also, most beneficiaries reside in the normal area of business activity of one or more DME supplier(s) and have reasonable access to them .
Therefore, DME carriers may not allow separate delivery and service charges for oxygen or
DME except as specifically indicated in §§90 or in rare and unusual circumstances when the delivery is not typical of the particular supplier’s operation .
For example, there may be situations in which it is necessary for a DME dealer to incur extraordinary delivery expenses in order to meet the needs of beneficiaries living in remote areas that are not served by a local dealer or when a local dealer is temporarily out of stock of required oxygen or equipment . For example, DME carriers may recognize a reasonable separate delivery charge when the supplier must deliver an item of DME outside its normal area of business activity and the beneficiary does not have access to a supplier whose location is nearer .
When a supplier delivers oxygen or DME outside the area in which he/she normally does business, but the item could have been obtained locally, carriers may allow any separate additional delivery charge only to the extent that it does not raise the total payment for the oxygen or DME above the local fee schedule .
When a separate charge can be allowed for delivery/service, carriers base the amount
(based on mileage or a flat rate) on all of the relevant circumstances, including:
• The time and distance traveled;
• The actual additional expenses incurred by the supplier;
• The type and quantity of equipment or oxygen delivered;
• The supplier’s customary charge under such circumstances;
• The prevailing charges in the locality under such circumstances; and
• Delivery charges made elsewhere in similar localities. Any separate delivery charges recognized because of unusual circumstances may, of course, be paid for only for deliveries that have actually been made .
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(Rev. 1, 10-01-03) B3-5105 (continued)
Suppliers must be advised in the carrier service areas to bill a separate delivery charge only in those rare situations in which “unusual circumstances” were encountered . Information issuances should be used to advise DME suppliers of the need to fully document unusual circumstances on claims/bills for separate delivery charges . If a supplier, nevertheless, routinely itemizes delivery charges, carriers may consider payment for the charges to be included in the fee for the equipment .
06-89 COVERAGE AND LIMITATIONS 2100.4
Maintenance – Routine periodic servicing, such as testing, cleaning, regulating and checking of the beneficiary’s equipment is not covered . Such routine maintenance is generally expected to be done by the owner rather than by a retailer or some other person who charges the beneficiary . Normally, purchasers of DME are given operating manuals which describe the type of servicing an owner may perform to properly maintain the equipment . Thus, hiring a third party to do such work is for the convenience of the beneficiary and is not covered .
However, more extensive maintenance which, based on the manufacturers’ recommendations, is to be performed by authorized technicians, is covered as repairs .
This might include, for example, breaking down sealed components and performing tests which require specialized testing equipment not available to the beneficiary .
Replacement – Replacement of equipment that the beneficiary owns or is purchasing is covered in cases of loss or irreparable damage or wear and when required because of a change in patient’s condition . Expenses for replacement required because of loss or irreparable damage may be reimbursed without a physician’s order when in the judgment of the carrier the equipment as originally ordered, considering the age of the order, still fills the patient’s medical needs . However, claims involving replacement equipment necessitated because of wear or a change in the patient’s condition must be supported by a current physicians order . (See §2306D in regard to payment for equipment replaced under a warranty .)
Repair shops are key components of a successful Rehab/DME business .
A properly staffed and efficient repair center establishes Rehab or general DME suppliers as experts in their field .
Your repair shop should be accessible and hours should be clearly posted .
A good repair center will create additional sales opportunities as well as establish your company as someone who can be trusted .
Continuing education of your sales force, your order intake personnel and your repair staff is imperative .
Everyone needs to know the basic information that is required from the beginning .
1 . Collect funding information .
If you know where the money is coming from before you start, you can process the repair and payment without loss .
Your customer service staff should also be thoroughly trained on all types of funding . They need to understand the equipment, too .
They need to be friendly and helpful .
They need to be presentable .
All information needs to be collected before an appointment is made .
2 . Once funding is established, set up an appointment and have an experienced technician do the evaluation and cost analysis . This will save you time and money and help your bottom line .
Submit for prior authorization, if required, before any repairs are completed .
Do the repair . Make sure all items are entered on the work sheet . Don’t let the technicians become lax on keeping track of items used . One bracket, bolt, etc . may be cheap, but 100 brackets, bolts, etc . can add up .
Submit for funding with the proper coding and information, including a breakdown of labor time . The name, make and models of pieces are very important . It is imperative for the repair staff to make legible notes and give the information to billing staff in a format that they can follow .
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• Inspect it:
• Check for broken, missing and loose pieces .
• Inspect the frame for any damage, bent tubes, broken welds . Inspect the upholstery
for tears or splits . Check seat for foam wear .
• Keep it clean:
• Wipe any excess dirt or grime from your wheelchair . Dirt and grime can
compromise the smooth movement, create rust and damage moving parts .
• You can use a general purpose cleaner to wipe down the frame, wheels, tires and
hand rims on the chair .
• Wipe the upholstery clean, but do not use petroleum-based cleaners because they
can damage the upholstery .
•Keep it lubricated:
• All pivot points on the chair need to be lubricated regularly with a multi-use
lubricant to prevent dust and repel moisture .
• Keep it tight:
• Check no less than once a month for loose nuts and bolts .
• Check tires:
• Are the tires showing excessive wear? If so, they need to be replaced .
• Check for loose or damaged spokes .
• Make sure all tires are inflated correctly . Flat or low tires use up excess battery
power and make wheelchairs hard to operate .
• Check wheel locks to ensure they are tight . They are essential for safe patient
transfer . Inspect closely to make sure they are not bent .
• Check batteries:
• Make sure batteries are properly installed .
• Check for proper charging and ensure the charger is functioning correctly .
• Check all cables to ensure they are tight and there is no corrosion on the terminals .
See the following Power Wheelchair Service Checklist .
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Customer Name: ______________________________ Date of Service: _______________________________
Manufacturer: ________________________________
Repair Tech: __________________________________
Make/Model: _________________________________
Serial #: ______________________________________
Description of Service:
Upholstery: Check for sags, tears and splits, check foam for wear
Tires: Check for excessive wear/tire pressure
Spokes/Rims: Check tightness and for broken/missing spokes
Wheel release lever: Check for tightness and adjust
Bearings: Check for condition and adjust all bearings
Front riggings: Check foot plates/ legrest/springs/straps
Frame: Check for damage, bent tubes, broken welds
Remove arms: Adjust height/inspect
Folding chairs: Ensure proper folding
Check tips and grips for wear
Verify all accessories are correct and properly installed
Check seat/back if aftermarket for wear and proper installation
Ensure you have cleaned the chair thoroughly and properly
Check batteries for proper charge and any leaks
Ensure battery charger is working properly
Joystick/modules and battery box are mounted securely
Make sure kill switch is present and operable
Make sure chair is operating properly in all modes/directions
Alternate drives test functionality
Tilt/Recline: lubricated and tested
Condition Adjusted Replaced/Cost Repair/Cost
COMMENTS:
This wheelchair has been carefully inspected according to manufacturer’s specifications . If you have any questions or comments regarding this equipment, please contact our Customer Service Staff at your earliest possible convenience . Thank you for the opportunity to serve you .
Inspection ____________________________________________________________ Completed Repairs __________________________________________________
Technician_________________________________ Date __________________________ Technician_________________________________ Date ____________________
Customer_________________________________ Date __________________________ Customer_________________________________ Date ____________________
• Inspect It:
• Check for broken, missing and loose pieces on the chair.
• Inspect the frame for any damage, bent tubes, broken welds.
Inspect the upholstery for sagging, tears or splits .
• Keep it clean:
• Wipe any excess dirt or grime from your wheelchair, dirt
and grime can compromise the smooth movement, create rust and
damage moving parts .
• You can use a general purpose cleaner to wipe down the frame,
wheels, tires and hand rims on the chair .
• Wipe the upholstery clean. Do not use petroleum-based cleaners
on upholstery as these can damage the upholstery .
• Keep it Lubricated:
• All pivot points on the chair need to be lubricated regularly –
this can be done using a multi-use lubricant to prevent dust
and repel moisture .
• Keep it tight:
• Check no less than once a month for loose nuts and bolts.
• Check tires:
• Are the tires showing excessive wear? If so they need to be replaced.
• Check for loose or damaged spokes.
• Make sure all tires are inflated correctly. Flat or low tires use up
excess energy for user, making wheelchairs hard to push .
• Check wheel locks to ensure they are tight because they are
essential for safe patient transfer .
See the following Manual Wheelchair Service Checklist .
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Customer Name: ______________________________
Manufacturer: ________________________________
Date of Service: _______________________________
Make/Model: _________________________________
Repair Tech: __________________________________ Serial #: ______________________________________
Description of Service:
Upholstery: Check for sags, tears & splits
Tires: check for excessive wear/ tire pressure
Spokes/Rims: Check tightness
& for broken/missing spokes
Handrims/Hardware: Check tightness/damage
Wheel lock/Grade Aids: Check for tightness
Bearings: Check for condition
& adjust all bearings
Front riggings: Check foot plates/springs/straps
Frame: Check for damage, bent tubes, broken welds
Remove arms: adjust height/ inspect
Folding chairs: ensure proper folding
Check tips and grips for wear
Check all accessories for proper installation
Check seat/back if aftermarket for wear & proper installation
Make sure you have cleaned the chair properly
Condition Adjusted Replaced/Cost Repair/Cost
COMMENTS:
This wheelchair has been carefully inspected according to manufacturer’s specifications . If you have any questions or comments regarding this equipment, please contact our Customer Service Staff at your earliest possible convenience . Thank you for the opportunity to serve you .
Inspection ____________________________________________________________ Completed Repairs __________________________________________________
Technician_________________________________ Date __________________________ Technician_________________________________ Date ____________________
Customer_________________________________ Date __________________________ Customer_________________________________ Date ____________________
General: Responsible for the repair and maintenance of all company-owned rental equipment and customer-owned equipment in need of repair . Maintains appropriate documentation, establishes, implements and monitors policies and procedures regarding the servicing of equipment and delivery of same . Instructs patients on proper use and care of equipment (except transfer techniques); must have high level of product knowledge on all respiratory equipment and DME. Maintains assigned company vehicle and repair shop; other tasks as requested .
Qualifications
Physical:
1 . In an average 8-hour day, the employee lifts/carries up to 65 pounds frequently .
2 . In an average 8-hour day, the employee stands/walks 7 hours .
3 . In an average 8-hour day, the employee sits 1 hour .
4 . In an average 8-hour day, the employee drives 0 hours .
5 . The employee lifts/carries up to 100 pounds maximum .
6 . Must be clean and neat in personal appearance .
Education:
1 . High school diploma or G .E .D . equivalent preferred .
2 . Previous repair experience preferred .
Experience/Knowledge/Personality:
1 . Able to work independently with minimal supervision .
2 . People-sensitive characteristics with a desire to help others .
3 . Able to function as a polite and cooperative team member with a positive attitude .
4 . Must be detail-oriented .
5 . Excellent driving record .
6 . Mechanical abilities required .
7 . Computer experience preferred .
8 . Able to maintain confidentiality .
9 . Good communication skills .
10 . Must be able to read, write and speak English fluently .
On Call:
1 . Periodically available for non-office hours .
2 . Willing to be trained in pertinent areas of equipment/supplies .
3 . Available for home/office visits .
-continued-
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-continued-
Responsibilities
Responsible for:
1 . Maintaining an accurate and efficient workflow for processing rehab orders and
related documentation .
2 . A working knowledge of computer system to include order entry, inventory, notes,
report writing and accounts receivable .
3 . Assisting with obtaining all required documentation, authorizations, verifications,
and waivers for proper payment of rehab products . Responsible to respond in a
timely manner to requests for additional information, and to investigate problems
and resolve with appropriate staff .
4 . Assisting with placing orders for wheelchair and accessories through
materials department .
5 . Repairing specialty or high-end wheelchairs, which includes setting schedule
for pickup, delivery, providing loaner - p .r .n ., ordering replacement parts, repairing,
documenting repairs for billing, and making appropriate notes in computer system .
6 . Keeping current on third party reimbursement issues and
documentation requirements .
7 . Setting up appointments for fittings, deliveries, etc . in conjunction with customer
service staff and Rehab Specialist .
8 . Assisting with deliveries and setups as requested by Rehab Specialist
and/or branch manager .
9 . Assisting with inventory control of rehab products and assuring that warehouse
is a safe, organized, efficient environment .
9 . Filing charts and contents accurately and in a timely manner .
10 . Maintaining confidentiality about all customer charts and secure files at close of business day .
11 . Auditing customer charts according to company guidelines . Assist with report completion as requested .
12 . Providing support and assistance to other departments as needed .
13 . Maintaining clean, neat, and orderly work area .
14 . Being on call per company policy .
15 . Attending in-store meetings .
16 . Performing other duties as deemed appropriate by management .
General: The Rehab Specialist is responsible for fitting, adjusting, and assembling rehab and other high-tech equipment . Provides instructions to patients and referral sources, is knowledgeable about third party reimbursements, and markets the company’s rehab services .
Qualifications
Physical:
1 . In an average 8-hour day, the employee lifts/carries up to 65 pounds frequently .
2 . In an average 8-hour day, the employee stands/walks 3 hours .
3 . In an average 8-hour day the employee sits 2 hours . (These hours include up to 2
hours of data entry/phone work)
4 . In an average 8-hour day, the employee drives 3 hours .
5 . The employee lifts/carries up to 85 pounds maximum .
6 . Must be clean and neat in personal appearance .
Education:
1 . High school diploma .
2 . Two years’ rehab experience or approved training .
Experience/Knowledge/Personality:
1 . Able to function as a polite and cooperative team member with a positive attitude .
2 . Good computer skills preferred .
3 . Good oral and written communication skills .
4 . Must be detail-oriented .
5 . People-sensitive characteristics with a desire to help others .
6 . Able to work independently .
7 . Certification may be required .
8 . Able to maintain confidentiality .
On Call:
1 . Periodically available for non-office hours .
2 . Willing to be trained in pertinent areas of equipment and supplies .
3 . Available for home/office visits .
4 . Good driving record .
-continued-
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-continued-
Responsibilities
Responsible for:
1 . Responsible to set up appointments for fittings, delivery, etc . in conjunction with
customer service staff .
2 . Responsible to do fittings and complete all appropriate paperwork .
3 . Responsible to obtain all required authorizations, verifications, and waivers for
proper payment, through appropriate staff per policy and procedure .
4 . Responsible to place order for wheelchair and accessories through
materials department .
5 . Responsible to deliver equipment or make arrangements for delivery and verify fit,
equipment function and performance, with complete and accurate documentation .
6 . Responsible for knowledge of third party reimbursement issues and
documentation requirements .
7 . Responsible for safe operation and routine care of company vehicle .
8 . Assist with other deliveries and setups as requested by branch manager .
9 . Provide accurate, timely information to controller for commission calculation
on a quarterly basis .
10 . Assist with inventory control .
11 . Assist with on-call per request of branch manager and time constraints .
12 . Attend in-store meetings .
13 . Perform other duties as deemed appropriate by management .
Characteristic Duties and Responsibilities
• Evaluation of patients for mobility and seating systems.
• Working in a team environment.
• The team will be composed of patient, caregiver, physician, therapist, case manager
• Setup of equipment for simulation.
• Completing equipment order forms.
• Creating pricing quotations.
• Working with Rehabilitation Service Technician (RST) on final assembly
and quality assurance .
• Delivery and fitting equipment.
• Communicating with the rehab team on any changes of equipment or patient status.
• Patient follow-up to ensure that the goals of the service plan are met.
• Communicating insurance coverage benefits, limitations and other issues.
• Functional oversight of various operational and/or clinical duties.
• Participates in the development and implementation of policies and procedures.
• Development, monitoring and reporting on relevant metrics for oversight areas.
Physical requirements
• Ability to read, write, speak and comprehend English.
• Functional visual acuity and hearing for accurate assessment and recording of
patient observations and information .
• Manual dexterity to perform required procedure activity proficiently and safely.
• Ability to lift up to 75 pounds to perform transfer of medical, surgical
equipment and supplies .
Working conditions and occupational hazards
• Performs assigned duties in assigned locations.
• Risk of exposure to infectious diseases and blood-borne pathogens through
patient contact .
• Drives a delivery vehicle to various locations in all weather conditions on
a regular basis .
Qualifications
• RESNA ATS/P certified.
• Active NRRTS membership with CRTS credentials.
• Three to five years’ rehabilitation experience (preferred) may include clinical,
technician, or RTS .
• A working knowledge of insurance/billing requirements and reimbursement levels.
• Excellent communication skills.
• A strong desire to maintain a high level of quality standard or practice.
• Willing and able to attend seminars and trade shows to maintain certifications
and NRRTS membership .
Education
• Associate degree in physical medicine or related curriculum (minimum).
• Bachelor’s degree in physical medicine or related curriculum (preferred).
• Attendance at advanced seating and mobility seminars.
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Characteristic Duties and Responsibilities
• Evaluation of patients for mobility and seating systems.
• Working in a team environment.
• The team will be composed of patient, caregiver, physician, therapist, case manager
• Setup of equipment for simulation.
• Completing equipment order forms.
• Creating pricing quotations.
• Working with Rehabilitation Service Technician (RST) on final assembly and
quality assurance .
• Delivery and fitting equipment.
• Communicating with the rehab team on any changes of equipment or patient status.
• Patient follow-up to ensure that the goals of the service plan are met.
• Communicating insurance coverage benefits, limitations and other issues.
Physical requirements
• Ability to read, write, speak and comprehend English.
• Functional visual acuity and hearing for accurate assessment and recording of
patient observations and information .
• Manual dexterity to perform required procedure activity proficiently and safely.
• Ability to lift up to 75 pounds to perform transfer of medical, surgical equipment
and supplies .
Working conditions and occupational hazards
• Performs assigned duties in variety of locations.
• Risk of exposure to infectious diseases and blood-borne pathogens through
patient contact .
• Drives a delivery vehicle to various locations in all weather conditions on a
regular basis .
Qualifications
• RESNA ATS certified or RESNA eligible within two years.
• Active NRRTS membership or eligible within minimum required time frame.
• Three to five years’ rehabilitation experience (preferred) may include clinical,
technician, or RTS .
• A working knowledge of insurance/billing requirements and reimbursement levels.
• Excellent communication skills.
• A strong desire to maintain a high level of quality standard or practice.
• Willing and able to attend seminars and tradeshows to maintain certifications
and NRRTS membership .
Education
• High school diploma or equivalency (minimum).
• Associate degree in physical medicine or related curriculum (preferred).
• Attendance at seating and mobility seminars.
Name: ______________________________________
INSTRUCTIONS: Complete this skill sheet . Use the “comments” section to state comments or issues .
Skill Level Legend: 1 = No contact w/equipment or this situation . No knowledge of procedure .
2 = Understand procedure and situation but never performed task .
3 = Have performed this task infrequently and would need supervision .
4 = Have performed this task frequently and can perform independently .
For competency testing review skills of staff and grade accordingly .
Legend: E = Excellent
S
N = Needs Improvement
N/A = Not Applicable
Competency testing is completed on hire and on an annual basis.
SKILL LEVEL Skills
TOPIC
Communication skills
1 2 3 4 Review COMMENTS
Verbal
Written
Medical terminology
Typing __________ WPM
Computer skills
Computer programs
_________________________________
Order building/cognitive assessment/fitting
Troubleshooting
Electromechanical ability
Patient
Rights and responsibilities
Complaint Procedure
Source of referrals
Medicare coverage criteria
Medicaid coverage criteria
Private insurance procedures
Managed care contracts and authorizations
Billing process
CMN auditing
Infection control procedures
Occurrence reporting
Handling complaints
-continued-
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-continued-
TOPIC
Delivery/setup/troubleshooting/fitting
Tilt/recline systems
Batteries
Drive control programming
Drive system interfaces
Remote electronics
Integral electronics
Elevating seats
Power seating systems
Power wheelchairs /cushions/ seating
Lifts/traction/trapeze
Walk aids/bath aids
Other equipment as stated
Proper body mechanics and lifting
Proper vehicle use and loading
Specialty Interest Area:
1
EQUIPMENT
SKILL LEVEL
2 3 4
Skills
Review
Comments (any additional skills) :
Attachments (any certificates of completion from participation in technical repair courses) :
COMMENTS
Signature: ___________________________________________ Date: ___________________________
Reviewed by: _________________________________________ Date: ___________________________
Assistive Technology Professional Competency
Name: ______________________________________
INSTRUCTIONS: Complete this skill sheet . Use the “comments” section to state comments or issues .
Skill Level Legend: 1 = No contact w/equipment or this situation . No knowledge of procedure .
2 = Understand procedure and situation but never performed task .
3 = Have performed this task infrequently and would need supervision .
4 = Have performed this task frequently and can perform independently .
For competency testing review skills of staff and grade accordingly .
Legend: E = Excellent
S
N = Needs Improvement
N/A = Not Applicable
Competency testing is completed on hire and on an annual basis.
TOPIC
Communication skills
1
SKILL LEVEL
2 3 4
Skills
Review COMMENTS
Verbal
Written
Medical terminology
Typing __________ WPM
Computer skills
Computer programs
_________________________________
Order intake procedures
Order building /fitting/cognitive assessment
Diagnosis and ICD-9 codes
Patient
Acceptance criteria
Rights and responsibilities
Complaint procedure
Source of referrals
Medicare coverage criteria
Medicaid coverage criteria
Private insurance procedures
Managed care contracts and authorizations
Billing process
CMN auditing
Infection control procedures
Handling complaints
Electro-mechanical ability
Troubleshooting capability
-continued-
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-continued-
TOPIC
Cash handling
Occurrence reporting
Handling complaints
1
SKILL LEVEL
2 3 4
TOPIC
Delivery/setup/troubleshooting/ fitting
Batteries
Tilt/recline systems
Drive control programming
Drive system interfaces
Remote electronics
Integral electronics
Elevating seats
Power seating systems
Wheelchairs /cushions
Lifts/traction/trapeze
Walk aids/bath aids
Other equipment as stated
Proper body mechanics and lifting
Proper vehicle use and loading
Specialty Interest Area:
1
EQUIPMENT
SKILL LEVEL
2 3 4
Skills
Review
Skills
Review
Comments (any additional skills) :
Attachments (any certificates of completion from participation in technical repair courses) :
COMMENTS
COMMENTS
Signature: ___________________________________________ Date: ___________________________
Reviewed by: _________________________________________ Date: ___________________________
Employee performance evaluation
Position: Service Technician
Employee: _______________________________________ Date: __________________
Rating Scale:
0 = Performance is unacceptable, immediate improvement required
1 = Performs as expected occasionally, needs reinforcement
2 = Performs as expected most of the time
3 = Performance is exemplary, exceeds expectations
Quality of Work:
1) Performs repairs efficiently and accurately .
2) Follows all driving rules and regulations, including DOT requirements .
3) Follows all infection control protocols and universal precautions .
4) Utilizes proper safety and personal protection devices at all times as necessary .
5) Obtains complete required signatures and dates on all forms given to clients .
6) Provides complete documentation whenever required to document any unusual circumstance
regarding a delivery or call .
7) Greets clients and visitors in courteous manner by introducing self and calling clients by name .
8) Performs daily vehicle inspections .
Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
Quantity of Work:
1) Completes all assigned work during scheduled shift .
2) Is ready for morning departure unless unusual circumstances arise and cause delays .
3) Performs minor repairs on manual equipment consistently and effectively .
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Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
Knowledge of Job: 0 1 2 3
1) Demonstrates understanding of Universal Precautions and clearly understands infection control
policies for cleaning equipment .
2) Demonstrates an understanding of all manual equipment delivered and a basic operating
knowledge of power equipment .
3) Understands and abides by all state driving laws and regulations .
4) Demonstrates awareness and understanding of job description and job responsibilities .
5) Attends and contributes to in-services .
6) Understand basic repairs to manual equipment .
Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
Judgment and Decision Making:
1) Consults with supervisor when unusual or urgent situations occur .
Does not make impulsive decisions .
2) Decisions are always based on policies and procedures .
Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
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Reliability and Initiative:
1) Arrives on time at start of the workday .
2) Returns promptly from lunch/breaks .
3) Provides proper notification for scheduled absences .
4) Follows procedures for reporting tardiness .
5) Attends to personal affairs without letting them disrupt work schedule .
6) When requested, is willing to work additional hours .
7) Recognizes the needs for and performs additional, unassigned tasks .
8) Helps co-workers .
9) Maintains work area in an orderly manner .
Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
Safety and Infection Control:
1) Is knowledgeable on infection control practices .
2) Demonstrates knowledge of safety policies and procedures .
3) Completely understands and can describe emergency/disaster procedures (e .g ., what to
do in the event of a disaster)
Supportive documentation and comments: ____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Total points: __________ Average: __________
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N/O 1
Not Observed Unsatisfactory
2
Needs
Improvement
3
Meets
Expectations
4
Exceeds
Expectations
5
Exemplary
Assessment Date: ______________________
General: Appearance: Reflects professionalism and adherence to dress code as stated in the company’s policy and procedures manual, personnel policy section .
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Dependability: is punctual and works scheduled hours (part-time/full-time), with minimum absence and/or requested personal time off .
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrates accountability and trustworthiness as a staff member/ representative of
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Learning Aptitude: Capacity for learning and general suitability .
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N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Retention: Ability to recall and apply learned and experienced technical skills in the performance of assigned tasks .
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Communication skills, written:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Communication skills, oral:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Productivity, in shop and field:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Understanding/Execution of Return Authorization (R.A.) procedures:
Coordination, proper routing and filing of return authorization forms .
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Understanding/Execution of Service Repair Orders (SRO) and Service Repair Requests (SRR): Generation and proper routing of forms associated with repair orders .
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrated ability in determining client pay sources:
2
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3 N/O 1 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Understanding, and ability to explain costs, prior authorization and other required information, to clients:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Skills; Troubleshooting/Evaluation of Equipment:
Demonstrated ability to troubleshoot and repair various makes and models, manual wheelchairs:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrated ability to troubleshoot and repair various makes and models, power mobility bases, MECHANICAL:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Demonstrated ability to troubleshoot and repair various makes and models, power mobility bases, ELECTRONICS and ELECTROMECHANICAL:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Scooter evaluation and repair, various makes and models,
MECHANICAL, ELECTROMECHANICAL and ELECTRONICS:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Evaluation and repair of lift chairs, various makes and models,
MECHANICAL and ELECTROMECHANICAL:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrated ability to troubleshoot and repair hospital beds, various makes and models, MECHANICAL and ELECTRO-MECHANICAL:
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N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrated ability to setup, operate and instruct oxygen equipment, especially oxygen concentrators, oxygen tanks and their associated valves and fittings:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Demonstrated ability to properly install and repair various seating systems and their related components:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Overall technical skills and aptitude:
N/O 1 2 3 4 5
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Position: _____________________________________
Quality of Work
Quantity of Work
Knowledge of Job
Judgment and
Decision
Making
# of
Points
# of
Standards
Average
Reliability and
Initiative
Overall
Rating
Developmental goals and training needs: _____________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Employee comments: ________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Supervisor comments: _______________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Supervisor signature: ____________________________________ Date: ____________
Employee signature: _____________________________________ Date: ____________
U.S. Rehab has partnerships with top-rehab vendors for quality products, services and preferred pricing.
AbleNet, Inc
800-322-0956
www.ablenetinc.com
Specializes in educational and assistive technology solutions to help children and adults with disabilities lead productive and fulfilled lives.
Blue Chip Medical Products, Inc.
800-795-6115
www.bluechipmedical.com
Specializes in therapeutic mattresses, overlays, seating & positioning cushions and patient safety products.
Comfort Company
800-564-9248
www.comfortcompany.com
Specializes in seating and positioning products for geriatric and rehabilitation clients.
Harmar
800-833-0478
www.harmar.com
Specializes in patient lifts, vehicle lifts, stair lifts, vertical platform lifts, incline platform lifts, cargo lifts, bath lifts and ramps.
Innovative Concepts
800-676-5030
www.icrehab.com
Specializes in adaptive seating products and services.
Innovation In Motion
800-327-0681
www.mobility-usa.com
Specializes in power wheelchairs and
Ormesa pediatric products.
Invacare
800-333-6900
www.invacare.com
Specializes in home and long-term care products.
Medical Applications
800-594-9166
www.medicalappsonline.com
Specializes in wheelchair accessories and hardware.
Medical Equipment Services
781-246-0523
www.powerwheelchairelectronicrepairs.com
Specializes in power wheelchair and power chair electronic repairs.
MK Battery
800-372-9253
www.mkbattery.com
Specializes in batteries for HME/mobility; one of the largest sealed lead acid battery providers in North America.
Motion Concepts
888-433-6818
www.motionconcepts.com
Specializes in wheelchair tilt and recline systems.
Permobil
800-736-0925
www.permobil.com
Specializes in high-end power mobility.
PDG: Product Design Group
888-858-4422
www.pdgmobility.com
Specializes in providing better mobility products for people with extra special needs.
PRM: Precision Rehab Manufacturing Inc.
814-725-8731
www.prmrehab.com
Specializes in custom seat and back cushions.
Prism Medical
866-891-6502
www.prismmedicalltd.com
Specializes in safe patient handling.
RAZ Designs Inc.
877-720-5678
www.razdesigninc.com
Specializes in rehab commode shower chairs.
Richardson Products
888-928-7297
www.richardsonproducts.com
Specializes in seating and positioning.
Rifton Equipment
800-571-8198
www.rifton.com
Specializes in pediatric mobility.
The ROHO Group
800-851-3449
www.therohogroup.com
Specializes in DRY FLOATATION ® , from wheelchair cushions to a full line of shape-fitting products.
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Greg Packer
Vice President
Peggy Walker, RN
Billing and Reimbursement Adviser
Carrie Etten
Administrative Assistant
Elizabeth Cole
Director of Clinical Rehab Services