Member Spotlight: BLACKBURN'S Paves the Way for Billing & Reimbursement in Home Accessibility
on April 28, 2023
VGM Live at Home is continuously impressed by the amazing work done by our members. From serving clients who need home modifications made to safely live in their homes to enhancing the home access profession, we are proud of our members in the home accessibility community.
One of our members, BLACKBURN’S, has done amazing work in the home accessibility industry for years.
BLACKBURN’S strives to be a clinical-based service provider encompassing all levels of medical equipment and supplies, which sets them apart from many competitors. Their goal is to consider all levels of care the individual may need from medical equipment to supplies.
Billing & Reimbursement in Home Accessibility
While reimbursement may not be a hot topic in the home accessibility industry, BLACKBURN’S has done a lot of work in this area and tried to educate fellow professionals about this. For example, the state of Pennsylvania used to cover home modifications only through waiver services. In 2021, the state separated home accessibility and home modifications into two categories of benefits and issued a medical policy regarding coverage guidelines. Home accessibility, now commonly referred to as Home Accessibility Durable Medical Equipment (HADME) is now considered for coverage under the member’s physical health benefits, not a waiver.
For an item to be considered as Home Accessibility DME, it must be removeable or reusable, and either needed because of a mobility impairment to be used to safely enter and exit the home or needed to support mobility activities of daily living. Examples of this include ramps, stair glides, ceiling lifts, and wheelchair lifts. Home Modifications, on the other hand, is anything done to structurally change the home (i.e., doorway widening for bathroom access).
Complex Rehab and Home Accessibility
Coverage of HADME is very similar to what BLACKBURN’S already succeeds in, which is complex rehab technology (CRT). BLACKBURN’S rehab department consists of nine certified ATPs. In fact, the department was recognized nationally by HME as the Best Rehab Provider in 2006, and a major percentage of the rehab staff has been tenured for 20+ years of service at BLACKBURN’S.
However, their home accessibility department continues to grow. Their home accessibility department started small with stair lifts and ramps over 12 years ago. Today, the department consists of a full-time staff who are trained and certified by the manufacturers for stairlifts, overhead lift systems, vertical platform lifts, and ramping systems they offer. Their employees are recertified on new manufacturer products as they are introduced, as many manufacturers have adapted new certification and training programs. This change will ensure products are installed in a safe and operational manner by trained certified technicians, something that BLACKBURN’S continues to succeed at.
Managing these two departments allowed BLACKBURN’S to combine their policies and procedures and develop a business model for Home Accessibility DME. The processes of home accessibility and complex rehab can be similar at times. Both require expert evaluators, and both sometimes require the involvement of a PT or OT to help recommend and justify the need for this equipment. Payor sources required a complete home assessment with diagrams, floorplans, pictures, and more. Home assessments include all activities of daily living in the home, including bathroom, kitchen, hallways, staircases, doorways, size of rooms, door widths, entrance/exit points, and more.
As details of coverage continue to get more defined by the state and their respective MCOs and Community Health Choice plans, BLACKBURN’S keeps their internal policies consistent with these changes. However, executing home accessibility and complex rehab in the same process has proven to be beneficial in many ways, especially for the customer, including greater response times, cost savings, and more.
As BLACKBURN’S views it, other states would benefit by allowing coverage of HADME. At its essence, it allows customers to remain in their home safely and for extended periods of time. By working with closely with rehab facilities to recognize the need for home accessibility prior to discharge, BLACKBURN’S is sometimes able to implement all that is needed in the home so when the customer is ready to be discharged, they can go to their home rather than a skilled nursing facility. Coverage of HADME can also reduce readmittance to emergency rooms due to falls, reduce the need for long term skilled nursing facilities, among many other benefits.
Thank you to BLACKBURN’S for sharing their process and demonstrating how other providers can advocate for the benefit of HADME in their own states. VGM Live at Home is proud to have BLACKBURN’S as Part of Something Bigger!
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