When looking at why claims are denied most of the reasons appear to be clerical or time errors.
- The request supplied incomplete or inaccurate information.
- The equipment or service was deemed not medically necessary.
- No diagnosis was indicated on prior authorization forms.
- The claim exceeded filing time limit.
- The equipment would not lead to an increase in self-care.
- Another device would be less costly, with no justification for the higher cost.
- There were typographical errors in the request.
In Building an Initial Information Base: Assisitve Technology Funding Resources for School Aged Students with Disabilities, had a lot of useful information on what resources can by used and reimbursed to students with disabilities. I was not aware that often time Medicaid is being used to fund assistive technology. I always thought the financial responsibility fell on the school district. It is important to remember that these devices will eventually need to be used outside of the classroom setting. In the classroom we are teaching students how to prepare themselves for life. Being able to get these technologies for students to use once they are out of school is extremely important as well.
Overall, I spent a great deal of time reading all of this weeks readings. However, I am sure that I will need to read these documents many more times in order to retain all of the information they hold. There was so much information this week that I didn't know.
Rebeccah,
ReplyDeleteThe process is grueling but worth it in the end if you can secure the device for a student. You bring up an excellent point when you mention that students need to have access to these technologies once they are out of school. I had a student who had a hearing aid and FM system that was funded by the district. There were errors with his Medicaid application and was about to be denied funding for a hearing aid. It was only through the incredible effort of the Social Worker and Speech and Language coordinator that he secured funding just in time to graduate and get funding for his new hearing aids.