Compliance and Cash-Based Physical Therapy Services

Table of Content

• Senior Director / Vice President - TCR Therapy Research
• WHAT IS CASH-BASED PHYSICAL THERAPY?
• MINDFUL MATTERS WELLNESS' PHYSICAL THERAPIST IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?
• Are PTs allowed to provide wellness services, or do we need to hire someone to provide these services?
• Pricing for Self-Pay Medicare Beneficiaries
• How to Set Up a Cash-Based Physical Therapy Practice Online
• Myth #2: You can treat Medicare patients “out of network.”

Incremental direct and indirect costs of untreated vasomotor symptoms. Hi David, my best suggestion is to call CMS and ask them where you can find out if you’re currently a Participating Provider … I don’t know of the specific url to check online but I’m sure they can point you in the right direction. I’m glad to see that the information I have managed to pull together matches what you have shared here. You have No relationship with Medicare (you have not enrolled as a “Participating Provider” nor as a “Non-Participating Provider”). Enter your info to join my newsletter and learn all 5 in this free article series.

The cheapest way to get from Frankfurt central train station to Strasbourg is to bus which costs $14 - $17 and takes 3h 35m. In the end, when you are an integral part of developing the goals and setting the plan of care, you help ensure your own improved outcomes. Paying cash for the services puts you in the right position to make the right decisions about your care. If they have no Part B benefits, then they do not have Medicare coverage for outpatient therapy services. It has helped dramatically shape my practice as a sole practitioner accepting only cash for services. I do have a question regarding what I was told when I called CMS.

Senior Director / Vice President - TCR Therapy Research

They are allowed to continue with an appeal, but if denied, they are responsible for the full bill of about $300 per hour! However even with a successful appeal, they can only receive about total of $3500 for reimbursement of PT + ST fees annually. More of us need to be familiar and comfortable with the Medicare regulations because, otherwise, we cede this domain to predatory Medicare Auditors who make their living off of physical therapists. I hope this post saves a lot of Physical Therapists a lot of time. With that said, I feel compelled to state again that I am not a lawyer and that any decisions based on this information should first be checked with an attorney.

As with most PT's who switch to a cash based model, my intentions have always been to put my patients first and give them the care they deserve. I can now say with certainty that I am able to provide them with a better patient experience than they would get anywhere else. We usually don't think twice about going out to buy nice workout clothes and healthy food, but when it comes to paying out of pocket for better health care we suddenly freeze up.

WHAT IS CASH-BASED PHYSICAL THERAPY?

Most health insurance policies don't cover the entire cost of a physical therapy visit. If cash-based physical therapy rates seem high to you, realize that even with health insurance, many patients are still responsible for copays and deductibles of $50 or more per physical therapy visit. So, you will usually pay out of pocket for physical therapy whether you use your insurance benefits or not.

I’m doing a big expansion of my Medicare and Cash PT e-book, and just realized I never answered your question. Thank you recommend being debt free, starting small and growing it organically. It is good to remember that I don’t have to start out in a clinic like I have grown accustomed to working in / supporting their choice for large facilities.

MINDFUL MATTERS WELLNESS' PHYSICAL THERAPIST IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?

Without the advice and resources you provided I don't know that it would have been possible. In your second example, purposely not getting the POC signed so that the services aren’t ‘covered’ is not a legal option. If the services are truly not medically necessary, and could be classified as wellness, fitness, or prevention, you should be fine to provide him with those services. However, I’m not totally sure on this one because I’ve never been a Non-Par Provider. I’ve work many places where I was also a Medicare Provider but that “number” does not follow me to my own private practice.

First, I would like my practice will be self-pay without insurance reimbursement offered or expected. In this scenario, would I have to worry about anything that Medicare or other insurance requires? I am asking this because although I will not be primarily offering physical therapy services, I will have an active physical therapy license. In contrast, CityPT follow-up treatments start at $99—less than half the cost of a traditional PT clinic. By eliminating the administrative overhead of billing insurance companies, cash pay physical therapists are able reduce their overall fees.

Restore Physical Therapy can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service. This allows Restore Physical Therapy staff to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices. In addition to your baseline forms, it is important that physical therapists also have their documentation notes organized.

I use the “Unknown” code for the ICD-10 section—it’s just a place-holder—and four units of therapy exercise for the CPT code. Demonstrating Skillful Decision-Making in Your Billing When you’re treating patients, your clinical decisions may feel like second nature. There are a few things you need to do in order to get started with cash-based PT. Rome2rio is a door-to-door travel information and booking engine, helping you get to and from any location in the world. The train from FrankfurtHbf to Strasbourg Bahnhof takes 1h 51m including transfers and departs three times a day.

Having a strong online presence has been proven to be an effective way in getting people to choose a provider. An important part of starting your own clinic is making sure that all legal areas of your clinic are addressed and up-to-date. Hiring a lawyer to help you through these areas is a beneficial step that physical therapists should consider taking when thinking of starting their own clinics. Making sure you obtain all of the appropriate business licenses and liability insurance is important in ensuring that your practice meets legal standards. Paying cash for physical therapy eliminates the mystery and math you would ordinarily experience when visiting an in-network therapist. In-network PT clinics charge an average of $250 per session to insurance companies.

You would first need to find out if “massage therapy” is a “covered service” under Medicare. If it is not a covered service, then you should be able to offer it on a self-pay basis. The patient should also be informed of what the services will cost. On the ABN they sign, the estimate of the cost should be included on the form, and what they actually pay needs to be within $100 or 25% of the estimate.

Does anyone know what the penalty is if a physical therapist does care a Medicare beneficiary without informing Medicare? Parient will sign “my” ABN stating I have no relationship with Medicare. This is very confusing but I don’t understand why Medicare cares if I charge a Medicare patient and don’t ask them for money. As of 2013, the Medicare “Therapy Cap” coverage denial was moved into the “medical necessity” category.

Outpatient physical therapy services are generally covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. In some cases, a Medicare beneficiary may pay cash for services that are no longer considered medically necessary, for example a "maintenance" or "wellness" program. Medicare may also allow cash payment for services beyond the Medicare cap for therapy services, currently $1880 per year. In these cases, the limits on what a provider may charge must comply with Medicare fee schedules.

When you are being treated in a cash based PT setting you build a really strong relationship with your therapist. You are probably going to be spending a lot of quality time together and end up feeling more like friends in the end. Trusting your therapist has a huge impact on your healing, and having the opportunity to get to know each other one-on-one really allows for a deeper sense of trust to develop.

When you hear about health care practitioners “Opting out” of Medicare, please know that this is an entirely different scenario than those described above and does not currently apply to Physical Therapists. At the time of this writing, Physical Therapists are not included in the list of practitioners who can “opt out” of Medicare . Though the details of this topic span far beyond what you’ll find below, this article remains a very good overview of the subject and starting point to further exploration of cash-pay opportunities with Medicare beneficiaries.