Smarter CRT meets stubborn payment realities

Complex rehab technology (CRT) is moving faster than the systems that are supposed to pay for it. AI-enabled operations, smarter power wheelchairs and more adaptive controls are setting a new baseline for what’s possible, while Medicare Advantage plans, Medicaid funding shifts and repair policies still operate on older assumptions, industry experts say. 

“CRT and DME providers continue to struggle with Medicare Advantage plans across the country,” said Tyler Mahncke, senior vice president of clinical mobility and accessibility at VGM & Associates. “The inconsistency of payment rates and improper denials continue to be an issue for various payers. Low rates, audits and recoupments also continue to be a large issue.” 

Smarter systems, smarter chairs 

Providers are leaning on technology to claw back time and predictability from a process that’s long been at the mercy of paperwork and payer lag. 

“The improvement to the operations side of the CRT businesses is arguably the most exciting part of what’s happening in our industry right now,” said Mahncke. “There is AI and technology that can be API’d or integrated into your billing software to take multiple steps of the process a lot faster, leading to getting the equipment to the client days, if not weeks, faster. This encompasses everything from speeding up the intake process, to gathering notes and collaborating digitally with the therapists and the ATP, to insurance verification, as well as scheduling and inventory management.” 

At Quantum Rehab, AI has moved from concept to standard tool, says Jay Brislin, vice president of the company. AI-driven robots now handle materials on the production floor, shortening shipping times and boosting productivity, while back-office systems use AI to refine roles, expectations and best practices. 

That same push is reshaping the hardware itself, and Brislin says now is the time to hit the gas. 

“Technology advancement is one the biggest pieces that we, as an industry, need to continue to level within our product offerings,” he said. “There are several advanced alternative drive controls on the market, as well as being developed, that can increase a client’s ability to operate their equipment in a more functional manner while reducing their daily fatigue.” 

Coverage gains, stubborn gaps 

On the policy side, the last two years have delivered concrete wins – particularly around access to power seat elevation – including increased coverage and formalized policies to cover the technology within six state Medicaid programs, with one more expected very soon, as well as 28 state-level advocacy actions. Even so, Wayne Grau, executive director of NCART, is blunt about where the risk lies. 

“We are very concerned about the changes to Medicaid funding,” he said. “Historically, we have seen irrational cuts to fee schedules and services by state governments seeking to save money in the short term. CRT providers are already not fully paid for all the services they provide and changes to fee schedules may be the tipping point that leads to reductions in services that consumers rely on.” 

2026: pressure and positioning 

Heading into 2026, advocacy priorities reflect both the momentum of recent wins and the fragility of the underlying payment structure. In the year ahead, Medicare coverage for power standing systems will continue to be a top federal priority. Beyond that, NCART is zeroing in on coverage, coding and proper payment for power standing, along with repair reform. On the business side, Mahncke is seeing a lot of private equity interest in the industry. 

“VGM and U.S. Rehab don't necessarily love to see this happen, but we are aware that it will happen, and we have ways of helping connect companies with similar goals and interests,” he said. 

Meanwhile, all of this is happening against a tense political backdrop. 

“We are very concerned about enacting policy changes in the current political climate,” said Grau. “With a very divided Congress, gridlocked legislation, federal staffing reductions to agencies like CMS, and government shutdowns have created additional challenges for advancing CRT priorities. We’ve learned a lot and are sharpening our strategies for 2026. We’re prepared to navigate what comes next.”