The hardest part of providing wheelchair seating-and-positioning systems for children is reimbursement-related, says Ann Greer, physical therapist (PT), Assistive Technology Provider (ATP), and co-owner of Rehab Dimensions LLC. Her Saint Marys, WVa, company works primarily with pediatric clients and, like most pediatric seating-and-positioning system providers, she is challenged to create systems that will last the payor-mandated 3 or 4 years no matter how much a child may grow.

“As funding agencies must be cost-conscious, you must come up with a seating-and-positioning solution that is going to allow for use of that wheelchair for at least 3 or 4 years,” Greer says. “That means the system has to be large enough that the child will not quickly outgrow it. But, at the same time, it cannot be so oversized in anticipation of growth that it compromises the child’s function for many months.”

To ensure that Rehab Dimensions provides a seating-and-positioning system that is correctly sized yet capable of accommodating growth, the staff perform comprehensive user evaluations that include visits to the homes of young clients in order to conduct environmental assessments. “We try to gather in-person input from as many family members, caregivers, and therapists as possible,” Greer says. “We believe that the more information obtained, the better able we are to meet the need of the child.”

Denying Denials
The other pediatric seating-and-positioning system reimbursement hurdle is getting timely payment and avoiding denials. Rehab Dimensions will not take any nonsense from insurance companies that use delaying tactics and, ultimately, decline to pay submitted bills.

“We simply refuse to accept rejection of our claims,” says Pat Stalek, Physical Therapy Assistant (PTA), Certified Rehabilitation Technology Supplier (CRTS), and Greer’s business partner. “Our motto is ‘We Deny Your Denial!’ I’m sorry to sound bellicose about it, but our position has to be ‘We did our job, now quit stalling and pay us.’”

Stalek marvels at the creative techniques payors have devised to avoid reimbursing for pediatric wheelchairs and seating-and-positioning services. “One of their current favorite dodges is to send claims to medical review, even though they were preauthorized,” she says. “Then there is coding. Since our pediatric focus necessitates that most of the equipment we provide is going to be extensively customized, we very often have no other choice but to submit claims using miscellaneous codes. However, if you do not submit claims with standard, specific codes, then that gives payors grounds to really scrutinize them. That, of course, allows them to hold up payment, if not outright deny the claims.”

Rehab Dimensions’ response to these and other payment-avoidance strategies is to simply dog the payors in pursuit of what is owed them. “We work the phones hard, we tirelessly climb the payors’ chain of command, and we do not stop making life miserable for them until we get satisfaction,” Stalek says.

Wheeler Dealers
Rehab Dimensions has provided wheelchairs and other rehabilitation equipment since 1997 when Greer and Stalek founded the company. Today the company employs two technicians, a pair of evaluators, an office manager, and a billing specialist.

The company’s success is notable in light of an ongoing market shakeout among its West Virginia competitors. Most of the rivals that perished did so due to an inability to satisfactorily address the funding issues surrounding mobility equipment, Stalek says. Other competitors remain in business but have abandoned their rehabilitation focus.

“Rehab Dimensions is now one of the state’s two remaining providers offering custom moldings for wheelchairs,” Greer says. “A big part of the reason we have been able to outlast the others is that Pat and I are clinicians who really understand pediatric seating and positioning.”

Have Client, Will Travel
Rehab Dimensions also has done well because of Greer’s and Stalek’s willingness to visit pediatric clients at home. “Many parents in West Virginia, which is mainly a rural market, lack the means to come to us, so we go to them,” Greer says. “In so doing, we are able to develop a greater level of intimacy with each client and with that child’s caregivers.”

Much loyalty toward Rehab Dimensions accrues from these road trips and traveling to patients is one of the reasons the company has no shortage of work. “We make a lot of friends among moms,” Greer says. “And those moms talk to other moms.”

The downside to visiting pediatric clients at home and at clinics is that Greer and Stalek must spend considerable amounts of time traveling. They serve the entire western half of West Virginia and part of southeastern Ohio.

In addition to word-of-mouth advertising, Rehab Dimensions also attracts business by participating in pediatric seating-and-positioning clinics sponsored by institutions and facilities around the state.

Other sources of new clients include school-based therapists, institutional discharge planners, social workers, and other health care professionals.

“We are not interested in doing those things that will lead to our becoming a huge company,” Greer says. “If we became a huge company, we would lose the intimacy that we currently enjoy with our clients....We like visiting clients at home. There is nothing more rewarding than seeing kids receive mobility equipment and watch how it changes their lives.”

Rich Smith is a contributing writer for Dealer/ Provider.