If you are interested in creating cash-based revenue for your physical therapy practice, but confused about the laws on taking self-payment from Medicare beneficiaries, then this episode is for you. Whether you are a:
- veteran practice owner who participates with Medicare,
- hybrid practice owner with Non-Participating status,
- cash-based practice owner not enrolled in Medicare,
- physical therapist hoping to become any of the above,
… very few seem to know when and if they can take private-payment from Medicare beneficiaries. The answer to this question actually changes depending a large number of factors, and they are all explained in this episode. TO DOWNLOAD A PDF OF THIS PODCAST EPISODE WITH ALL RELEVANT LINKS TO DIFFERENT PARTS OF MEDICARE LAW, CLICK HERE.
In this episode I read the first 22 pages of the Medicare and Cash-Pay Physical Therapy ebook and you will learn:
- The 3 possible relationships a physical therapist can have with Medicare and how this affects every decision you make surrounding this topic.
- How being a “Non-Participating Provider” is Not the same thing as “Opting Out” of Medicare.
- Why being a “Non-Participating Provider” is Not the same thing as having no relationship with Medicare.
- Why being non-enrolled or un-enrolling in Medicare is also Not the same thing as “opting out” of Medicare.
- The “Mandatory Claims Submission” law and how it affects your ability to provide cash-pay services to Medicare beneficiaries.
- The ONE exception the Mandatory Claims Submission law and how this exception can significantly change your ability to take self-payment from a beneficiary.
- How your specific relationship with Medicare dictates when/if you are able to provide covered services on a self-pay basis.
- The 3 reasons that services are not covered by Medicare.
- The scenarios in which covered services may become non-covered.
- How meeting the Therapy Cap may or may not change our ability to collect self-payment from that beneficiary, and the process that should be followed in doing so.
- The key factors you must know to determine when you can take cash-payment for “Maintenance Care”… sometimes you can and sometimes you cannot.
- How the 2009 HITECH Act and the 2013 HIPAA Omnibus Final Rule may or may not have created opportunities to treat beneficiaries on a cash-pay basis.
- When you should use an Advanced Beneficiary Notice (ABN) versus a Private Contract if you’ll be collecting private-payment from beneficiaries.
- The correct process for using an ABN when normally-covered services may no longer be covered due to lack of medical necessity.
Resources and Links mentioned in this episode:
- MEDICARE AND CASH-PAY PHYSICAL THERAPY – a Guide to the Rules and Regulations on Taking Private Payment from Medicare Beneficiaries
- MEDICARE AND CASH-PAY PHYSICAL THERAPY QUICK START GUIDE – a downloadable pdf of this podcast episode
If you are interested in the full-length book, access to all the links and sources, and over 30 more pages of information to clear up the confusion and fear most practice owners have surrounding this topic, click here to get it all.
Thanks Jarod for sharing the beginning of the book–really excellent info for any private practice PT! Looking forward to the release of the full book.
Thanks Julie! I appreciate the vote of confidence. One more week and the full-length book will be out!
Jarod- can you provide the reference for the 3 reasons services are uncovered? I am especially interested in the wellness/fitness reason. I want to be able to hold onto that reference so I can support offering these services on a cash-based basis even though we are participating providers. We wouldn’t need an ABN since they’re not covered, correct?
I first heard about the 3 reasons in an APTA webinar that is no longer available online, but in the law, what you’re looking for is Medicare Benefit Policy Manual, Section 220.2
(Page 82 at this link). I explain this all in detail in the Medicare ebook: bit.ly/CashPTMC
And yes, it is not mandated you have an ABN signed to provide the “never-covered” services of Wellness/Fitness but that doesn’t mean you can’t provide one (or something similar) explaining that the services are not covered and outlining the beneficiaries financial responsibilities.
Thank you so much!!
You are most welcome, Julie. Thanks for taking the time to say that. I deeply appreciate it.