Discover proven adaptive equipment solutions for occupational therapy that improve patient independence while ensuring insurance regulatory compliance.
Adaptive equipment occupational therapy is a crucial aspect of practice, from the evaluation through treatment. There’s a lot to consider when recommending or investing in adaptive equipment. However, maximizing the value and benefits involves more than just knowing how to use the equipment. Here, we’ll review strategies to utilize adaptive equipment (AE) to enhance outcomes and productivity, while leveraging documentation to increase reimbursement.
What is Adaptive Equipment
Adaptive equipment refers to any product, system, or device that assists individuals in performing activities of daily living (ADLs). There are many forms of adaptive equipment available. Custom-made, ready-made, and modified products are available.
Activities of Daily Living (ADLs) are basic, essential activities that people perform regularly to maintain their bodily functioning and well-being, such as:
- Bathing
- Personal hygiene and grooming
- Toileting and continence
- Eating and feeding
- Dressing
- Mobility
- Transferring
Instrumental activities of daily living (IADLs) are more complex ADLs that support people living independently, such as:
- Managing money
- Preparing meals
- Doing laundry
- Following a schedule for work or school
- Using public transportation
Adaptive Equipment VS Durable Medical Equipment (DME)
Adaptive equipment is any device that helps a person perform ADLs, simplifies caregiving, or makes the environment safer for a person with an illness or disability. Adaptive equipment does not require a prescription from a healthcare provider, so it’s not considered medically necessary by insurers. Examples include:
- Mobility aids (walkers, canes, and stair lifts)
- Home modifications (moveable kitchen cabinets, bathroom grab bars, and handrails)
- Devices for visual impairment (assistive phones, screen readers)
- Devices for hearing impairment (assistive phones, doorbell signalers)
- Devices for home safety (smoke alarms, nightlights)
- Eating devices (build-up utensil handles, divided plates, non-slip surfaces, non-spill cups)
- Kitchen devices (adapted cutting boards, jar openers, and adapted cooking utensils)
- Dressing devices (dressing sticks, sock-aids, zipper aids, reachers)
- Bathing (long-handled sponges, shower seats)
- Toileting (raised toilet seats)
Durable medical equipment (DME) is medically necessary equipment prescribed by a healthcare provider. Examples include canes, commode chairs, crutches, diabetes supplies, walkers, wheelchairs, patient lifts, and hospital beds. Coverage will vary by individual plan; however, DME is typically covered by Medicare Part B and some private health insurance plans. Equipment must meet specific criteria to be considered DME:
- Can withstand repeated use (durable)
- Medically necessary
- Used in the home of someone sick or injured
- Expected to last three years
Adaptive Equipment VS Assistive Technology
Assistive technology (AT) is any product, system, device, or equipment that is used to maintain or improve the functional ability of a person with a disability. AT can range from low to high tech and can be as simple as a pencil holder and as complex as educational software.
Typically, assistive technology supports people who have difficulty speaking, writing, typing, hearing, remembering, walking, and seeing. Different disabilities require different types of assistive technology, such as to support communication, mobility, or vision disabilities.
Typically, a single healthcare provider does not prescribe assistive technology; instead, it is recommended by a team of professionals, including speech-language pathologists, occupational therapists, special education teachers, family doctors, and other specialists. AT may be covered by various sources, including school systems, government programs, and, in some cases, private health insurance.
What is Adaptive Equipment for Occupational Therapy
In adaptive equipment occupational therapy, OTs use adaptive equipment as an assessment tool during evaluations and as an intervention for treatment. Some AE can be simple, such as adapted utensils for eating, or can include specialized equipment that serves as both an assessment tool and a treatment intervention.
Adaptive Equipment for Evaluations and Assessments
The primary focus of an occupational therapy evaluation is to assess how well the person can participate in meaningful activities, such as ADLs, job activities, and recreation or sports activities. A comprehensive OT evaluation will identify the underlying skills needed to perform specific, meaningful activities.
Basic Adaptive Equipment
Straightforward-tech adaptive equipment, such as a dressing stick, a divided dining plate, or a walker tray, may be used for evaluation by observing the client using the equipment during an activity. Document objective data by noting how the client was able to complete the associated task faster, safer, or with increased independence.
Other Advanced Equipment
Technologically advanced rehabilitation equipment has the capacity to simulate various activities, including ADLs and employment-related tasks, all in the controlled setting of a clinic. These advanced platforms of equipment provide functional task evaluation combined with objective measurements, allowing for accurate measurement of outcomes.
Using advanced, adaptive technology can streamline the evaluation process by helping you obtain accurate baseline data, which can inform your treatment plan and recommendations. Additionally, advanced AE will measure patient performance in real-time, enabling you to provide patients with immediate feedback and suggestions to support better outcomes.
Adaptive Equipment as Intervention
As with the evaluation process, adaptive equipment can be used as a treatment intervention or rehabilitation in occupational therapy. Practicing the use of equipment such as a reacher or buttoning aid may be practiced in the clinic. Advanced equipment may be used to practice ADL and job tasks while the clinician observes progress and skill development.
Safety Considerations for Adaptive Equipment
Whether the client will use adaptive equipment at home or in the clinic, ensuring safety is a priority. Demonstrating the use of low-tech AE with the client and any caregivers and reviewing precautions for use will promote safety at home. To protect yourself and your clinic, clearly document any instructions provided to the patient or other caregivers, and document that you reviewed any precautions or safety measures. State that the client of the caregiver demonstrated understanding or that you observed them using the equipment, and they followed safety precautions. In the clinic, patients need to be supervised when using any equipment to prevent injury and misuse.
Therapists and other providers must be appropriately trained to use any high-tech equipment or equipment used in a clinic. In-person or virtual training courses, provided by the manufacturer, can help you use your equipment easily and safely while maximizing its full potential. Participating in group training courses is an efficient way to train all occupational therapists in your clinic, enabling them to use the equipment with patients confidently from the outset.
Adaptive equipment, particularly high-tech equipment, requires thorough inspection and regular maintenance to ensure safety. Once again, it is essential to document that any maintenance is being completed on the recommended schedule.
You can reduce the risk of injury at home and in the clinic and protect your facility from lawsuits by documenting:
- Training for the patient’s caregiver
- Completion of training courses with therapists and assistants
- Adherence to the recommended maintenance schedule
Insurance Reimbursement Considerations for Adaptive Equipment
Just because it’s not considered medically necessary by insurers doesn’t necessarily mean that the adaptive equipment won’t be covered. The key to proper reimbursement is to objectively demonstrate outcomes, bill for services accurately, and apply evidence-based practices.
Reimbursement for Patients
Insurance coverage for adaptive equipment varies depending on the plan. Clients who contribute to an employer-sponsored health savings plan (HSA) may be eligible to use the funds towards adaptive equipment that they will use at home or in the clinic. Items such as dressing aids, adapted writing tools, and grip aids may all fit into this category.
Reimbursement for Clinics
Low-tech adaptive equipment may be reimbursed when your documentation supports its use in the clinic or to increase independence and safety at home.
The use of advanced rehabilitation equipment in the clinic may be billed as part of an occupational therapy evaluation or re-evaluation of progress, and to demonstrate positive outcomes to insurance payors. As an intervention or treatment, the use of advanced equipment may be billed as therapeutic activity or therapeutic exercise, as appropriate.
For example, using a folding board to fold laundry may be billed as a therapeutic activity. While using an advanced system to simulate work tasks as part of hand and upper extremity rehabilitation, such as turning resistive wheels to improve hand and arm strength and coordination, may be appropriately billed as therapeutic exercise.
Documentation and Evidence for Reimbursement
Insurance payers, whether Medicare or private insurance, require evidence of progress to approve reimbursement. Keep in mind that insurance reviewers are often not therapists and may not understand descriptions based on clinical judgment. Commonly, they’re nurses and other practitioners who may not understand the role of occupational therapy. That’s why it’s essential to include precise, objective measurements to demonstrate progress within documentation.
Additionally, insurance payers want to be assured that what you’re doing in the clinic or recommending for home will prevent injury or disease progression and reduce the need for additional assistance. The goal of documentation is to demonstrate to insurance payers that covering adaptive equipment now will prevent them from incurring higher reimbursement later, in the form of hospitalizations, urgent care visits, and home assistance.
Low-tech equipment used at home or in a clinic may be covered by Medicare or private insurers when documentation supports its use to improve independence and safety. For example, a raised toilet seat may be covered if it is clearly documented that the patient was able to use the toilet without assistance and adhered to post-surgical precautions when transferring from a sitting to a standing position.
In a do-more-with-less budget, advanced or high-tech adaptive equipment is a significant investment. As such, you’ll want to demonstrate the value of that investment. Advanced AE can enhance productivity in your clinic by enabling therapists to provide patients with comprehensive evaluations and treatment plans.
Evidence-Based Practice
It’s essential that any adaptive equipment, whether used as an assessment tool or an intervention, be backed by evidence-based research. How do you know if the adaptive equipment you’re considering is truly evidence-based and not just manufacturer hype? Look for transparency in the manufacturer’s literature regarding third-party research, outcomes, and how the equipment can help you make data-driven clinical decisions.
The Value of Adaptive Equipment in Occupational Therapy
Adaptive equipment occupational therapy is commonly used as part of evaluation and treatment, helping clinicians improve patient independence while demonstrating value to insurers By understanding how to use and document adaptive equipment effectively, you can maximize its value for both your patients and your clinic.
