Coverage Criteria & Mandatory Claims

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
3 reasons why services are not covered by Medicare, and the scenarios in which covered services may become non-covered

Therapy Cap, Maintenance Care, ABNs, & Cash-Pay Opportunities

How meeting the Therapy Cap may or may not change your ability to collect self-payment from the beneficiary, and the process you should follow 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 can't.
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 Advance Beneficiary Notice (ABN) versus a Private Contract if you'll be collecting private payments from beneficiaries.
The correct process for using an ABN when normally-covered services may no longer be covered due to lack of medical necessity.
Key information needed for ABN use with patients who have met the Therapy Cap.

Pricing Legalities and Guidance on Discussing this Topic with Patients

The checklist of “talking points” you’ll need when discussing payment with prospective patients as a Non-Participating provider
Crucial points to consider as a non-enrolled provider discussing treatment and payment with prospective Medicare-aged patients
The laws and regulations surrounding the Pricing of your services and the penalties you can incur with non-compliance
How those pricing rules change based on your relationship with Medicare, whether or not the services are normally covered and your compliance with the Physician Quality Reporting System (PQRS) and Electronic Health Records (EHR)

“Jarod Carter has developed the quintessential guide to navigating Medicare for the P.T. in private practice. Whether you are cash-based or not, this book is essential for having a place to look up the facts, questions and answers we all need to know to steer carefully through the Medicare guidelines. It has been carefully researched, referenced and written by a thoughtful expert practitioner who has taken his time, with professional colleague feedback, to develop the first ‘P.T. Medicare handbook of its kind.’ It has been not only a pleasure to read, but also useful to someone with 36 years of professional and private practice experience. Well done, Dr. Carter!

Larry Greenberg, PT, MS, M.Ed.
Martha’s Vineyard, Massachusetts

"Whenever I have any questions regarding cash-based physical therapy I turn to Jarod Carter …
and especially when it comes to Medicare and cash-based PT.
He does an amazing job sharing his expertise and clearing up a subject that is complicated and confusing. Lenny Macrina and I have leaned on Jarod several times in the development of our model at Champion PT and Performance, and this book has been an incredible guide for what we can and can't do when it comes to Medicare beneficiaries and our cash-pay services. I can't recommend it enough!"

Mike Reinold, PT, DPT, SCS, ATC, CSCS
Boston, Massachusetts

How do I differentiate between covered "skilled physical therapy" and non-covered services like "wellness," "fitness," and "prevention"? What does a compliant cash-pay fitness or wellness program look like?
What if a patient is only signed up for Medicare Part A and does not have part B or C? Some of my Medicare-aged patients have Part A, but maintain private insurance coverage for their outpatient healthcare (via their un-retired spouse’s work benefits). In this scenario, can we provide outpatient PT services on a private-pay basis?
I am not an enrolled Medicare provider. I have a prospective patient who is a Medicare beneficiary and is currently getting PT at another clinic, which participates with Medicare. He would like to see me as well on a cash-pay basis to receive more specialized and longer therapy sessions. Is this okay?
If I drop my provider status and only see Medicare beneficiaries for private-pay services, am I still required to document in the same way I was as an enrolled provider? How do treatment documentation requirements change?
Can practices have success being out-of-network with all 3rd Party Payors except for Medicare?
How do I find out if a patient has met the Therapy Cap?
Am I under the same limitations and regulations for retired military patients with TRICARE coverage, who want to see me on a cash-pay basis?
Can I change my Medicare-provider status? Exactly how do I do so?
What is the best Medicare-provider relationship for me and my practice?
If a patient is Medicare-aged but has a private insurance as their Primary, and Medicare as their Secondary insurance, can we see these patients on a private-pay basis just like we do with Non-Medicare patients who are privately insured?
What about patients with Medicare ADVANTAGE Plans (Part C)? Since they have signed their benefits over to a private insurer can I see them on a private-pay basis as if they were like my Non-Medicare patients?

"Jarod Carter's ebook 'Medicare and Cash-Pay Physical Therapy' is a very in-depth explanation of an extremely complex and confusing subject. He has painstakingly researched and answered virtually every conceivable scenario that a private practice owner need consider when dealing with Medicare patients. He provides countless resources for anyone wanting a more detailed explanation of the Medicare system. All in all, a tremendous resource for anyone in or contemplating a cash-based private practice and what their options are for dealing with Medicare patients."

David A. Wilderman, PT, DPT, MS
Wilmington, Delaware

Is this book geared solely towards cash-based practices, or is it for any type of PT practice? I participate with Medicare and do not want to change my provider status. I would like to know when it is and isn't allowed to take cash-payment when a beneficiary requests to pay privately, hits the Therapy Cap, joins my fitness program, etc.

This eBook is geared toward every type of physical therapy practice, and specifically addresses the rules and regulations pertaining to beneficiary private payment based on ALL 3 relationships a PT can have with Medicare. All the topics listed above are explained in detail for Participating providers as well as Non-Participating providers and non-enrolled providers.

I usually don't spend more than $25 on a book. What makes this one different and worth more than that?

Practice owners really need to know this information in order to not only avoid fines and disciplinary actions but also to avoid missing opportunities to treat this population on a cash-pay basis. I have gathered the information in this eBook from multiple sources over the course of 5 years. I can't imagine anyone being able to gather all this information with fewer than 25 hours of research/emails/phone calls, etc. So, as a businessperson, you have to ask yourself if your time is worth more than $2 per hour. Since your time is obviously worth far more than that, this eBook is a valid expense and great bargain - not to mention the hundreds/thousands of dollars it could save you in legal fees by having a guidebook to give your attorney with links to all the applicable parts of the laws they will be evaluating.

Does this eBook apply to related professions such as occupational therapy, speech pathology, chiropractic, or medicine?

This eBook is specific to the field of physical therapy. There may be a lot of cross over and matching regulations (especially with OT and SLP), but I have not researched those and cannot guarantee that all the rules are the same. The rules are most certainly different for physicians since they are on the list of practitioners who can "opt out" of Medicare. However, this eBook may still provide guidance to related professionals in terms of what questions to ask, where in Medicare regulations/manuals they can find answers, the overall structure of Medicare and the private-pay realm, etc.

I'm interested in having a cash-based practice someday, but it won't be for a while. Should I wait till I'm ready to start the practice before I buy this book and learn this information?

The preparation for starting a private practice should begin long before you see your first patient (if possible). This is a huge subject that isn’t easily grasped in a short period, so I would suggest familiarizing yourself with it as soon as possible. Certain segments of this eBook will also help you decide what relationship you want to have with Medicare and help you plan what cash-pay services to develop in your new practice. Having a clear idea of these relationships and potential opportunities can have a huge effect on your business plan, so I would suggest learning this material as soon as possible.

Shouldn't I be getting these answers from an attorney?

Absolutely! Some questions are best answered by an attorney, but even most healthcare attorneys are not well versed in this particularly obscure topic within the complicated world of Medicare law. This eBook is not a substitute for legal counsel, but it will educate you on the overall structure and laws surrounding this topic, and the different viewpoints of legal authorities and entities involved in it.

One of the things that makes this eBook so valuable is that it provides the resources, laws, and links to information an attorney will need to help you make the best decisions based on your specific situation ... likely saving them hours of time and saving you thousands of dollars.

If you want to be fully protected and informed, you will still need legal counsel, but this eBook is a great place to begin educating yourself (and your attorney) on all sides of Cash-Pay Physical Therapy and Medicare.

What's Your Plan for the Future?

Reimbursements for our services are on a steady decline. The exit of the Baby Boomers from the workforce will only further strain an already fragile system. As this happens and further cuts to provider payments are necessary to keep the system afloat, “tertiary” services like physical therapy will take some of the biggest hits.

Whether or not you want to participate with Medicare, all practices will need to find ways to increase revenue that is not based on third-party payer reimbursement. This is why the information in this eBook is so important for all current and future physical therapy practice owners and staff.

Do not wait until your back is against the wall before you try to figure out how to legally increase your cash-based revenue. And definitely don't guess whether or not you are compliant with current regulations. Get the whole story, gain clarity and move forward with confidence.

Learn how to capitalize on cash-pay opportunities without breaking laws and endangering your practice.

The penalties for noncompliance in this arena are enough to cripple most small-to-medium-sized practices.

Educate yourself today and make sure your practice continues to thrive in the future.

Jarod Carter PT, DPT, MTC

In 2005, Jarod earned his Doctorate in Physical Therapy from the University of St. Augustine. Since then he has continuously sought out skilled mentors and learning opportunities in manual therapy and business alike. He worked in both insurance-based and private-pay practices before opening Carter Physiotherapy in Spring 2010, a cash-based clinic where he provides an hour of one-on-one care in every treatment session. Via creative marketing and his reputation for producing fast results, his patient schedule was full within 6 months of opening his cash-based practice. In the fall of 2011, he released his first book My Cash-Based Practice and has been blogging, podcasting, and speaking on all aspects of the out-of-network practice model ever since. Jarod enjoys surfing, swimming, travel, and time with family. He married the girl of his dreams in April of 2015 and they welcomed twins in early 2018.

If you’re a therapist, physician, chiropractor or healthcare practitioner who wants to [INSERT BIG PROMISE] attract more cash-pay patients at no cost to you, and they already know you're out-of-network before they call ...

Then pay close attention to the special offer on this page because I can pretty much guarantee it will [more big promise/outcome] quickly and predictably put more money in your pocket with patients you don't have to convince to go out-of-network for your high-quality services.

That’s a bold promise I know, but I’ll share real-world proof in just a moment.

But first… In case we’re meeting for the first time, my name’s Jarod Carter. I’m the 10+ year owner of a thriving Cash-Based Physical Therapy Practice in Austin TX that has paid me more each and every year while requiring just 2-5 hours of my time per week.

I’m the author of the books “My Cash-Based Practice” and “Medicare & Cash-Pay Physical Therapy,” and host of “The Cash-Based Practice Podcast,” which I'm humbled to say has received over half a million downloads.

But most importantly, I’m a proud coach who has helped 100s of individual healthcare providers like you get out from under the thumb of greedy insurance companies and grow thriving Cash-Based Practices of their own, where they can control their time, their income & provide a level of care they’re proud of.

Now, I’m particularly excited you’re here on this page because whether you already run a Cash-Based Practice or you’re simply tired of the broken healthcare model and would like to transition Out of Network … I can say without a doubt this upcoming Masterclass solves…

[INSERT MAIN CHALLENGE SOLVED] The One BIGGEST CHALLENGE All Cash-Based Providers Must Overcome to Create Success

Not a day goes by where a client or online follower of mine doesn’t come to me with questions like…

[INSERT 3-4 QUESTIONS]

“How do I determine the right price to charge without outpricing my market or underpricing my care?”

“What if I’m afraid the price I want to charge will turn patients away, especially if they have insurance and can go elsewhere for care?”

“What should my staff and I say if we’re getting pushback or price resistance from potential or even existing patients?”

“How do I land more patients at a premium price without feeling pushy or salesy?”

If you ever find yourself asking questions like these… I’ve got great news for you!

This Masterclass Will Answer All Of Those Questions And More!

Think about this for just a moment…

[Edit the 'what would it feel like .." How would it feel, imagine .. etc - really utilize outcome statements and 'benefit of the outcome' statements that audience wants to experience.]

What would it feel like to walk through the door everyday knowing you and your team will get paid what you're worth?

How would it feel to easily provide extra time with a patient to assure they get a level of attention and care unavailable anywhere else?

Imagine flipping through an appointment calendar packed with long-term patients who are happy to pay a premium without thinking twice, because they see extraordinary value in the care you provide.

When you use the pricing strategies and the guidance you’ll get inside this masterclass, it’s beyond possible.

1-hour Masterclass where you'll learn [INSERT WHAT THEY'LL LEARN AND THE RESULT - above is written in first person so continue to use "I" "my" etc] the exact word-of-mouth and online-review strategies I share with my Gold Level Mastermind Members to ensure you are getting the most referrals from your current and past customers. ($197 value)
Post Masterclass Q&A I will answer all your questions live, so you will understand precisely how to implement these strategies immediately in your practice. ($147 value)
BONUS #1: High-Value Mini Training—"How to not get screwed by Yelp" ($97 value)
BONUS #2: Lead Management Tracker This tool makes it easy to keep track of your review requests so you don't miss any opportunities for positive buzz.
BONUS #3: Lifetime Recording Access Pay just once, but go back time and time again to extract the most powerful, profit increasing strategies I have to offer. ($147 value)

A crazy-simple two-step process at least double the amount of existing patients who become referral sources for your practice.
How to skillfully compel current patients to think of others in their life who may also need your services, without sounding salesy or directly asking for a referral.
How to make it as easy as possible for existing patients to refer your new patients, and massively increase the amount who actually follow through and become patients.
How Google reviews can help you beat large clinics with huge marketing and SEO budgets... at literally no cost to you!
The vital thing you must tell Yelp sales representatives when they call to get you to do pay-per-click ads ... know this tip or Yelp will make your best reviews invisible.
How to create automated systems that let you gather the greatest possible number of powerful online reviews without lifting a finger.
The simple strategy to ensure the reviews your clients write will actually produce new patients for your practice.
How to get your team in the habit of requesting reviews so you don't miss out on any positive buzz from your happy customers.
Followup strategies that convince busy customers to take the time to share their story.
How to reply to negative reviews in a way that can actually attract new patients.
Tech tricks that make it crazy simple and super fast for customers to post their reviews by eliminating extra steps and common sources of frustration.
The easy, reproducible 4-step plan that maximizes the visibility and impact of every positive review.
The exact script and process one of my Mastermind Members has used to accrue over 300 positive online reviews!

This was a great Masterclass! It made me sit down and look at where practice revenues slow and how to increase the revenue in creative ways. I realized revenue, for my pelvic health business, does not slow around the holidays, but ebbs and flows with the school year as many Moms are focused on their kids and less on their functional health goals. Thank you for also reviewing my "seasonal" idea about celebrating "Labor Day" for women one year post partum. Realizing seasonal promotions are not only holidays, but seasons related to our clients life and lifestyles was the best take away from this masterclass. Looking forward to more takeaways from more Masterclasses! Thanks!

—Amanda Heritage, PT, DPT, PRPC

Listen... it's possible you already have more patients than you can handle dying to pay a premium for you care...

But if that's not the case I can darn near Guarantee you this Masterclass can really help get you there! When you implement what you learn inside you'll quickly have more patients and reviews bringing cash-pay patients to your clinic doorstep ... happy to pay you top dollar without resistance.

Basically this Masterclass can give you an instant raise.

If that works for you... then go down below and dive in.

Ignorance of Medicare Laws onCash-Pay PT ServicesCould Leave You Defenseless AND Missing Huge Opportunities

The Vital Things You Will Learnin Just the FIRST HALF of This eBook:

Key Facts & Common Misconceptions

Coverage Criteria & Mandatory Claims

Therapy Cap, Maintenance Care, ABNs, & Cash-Pay Opportunities

Pricing Legalities and Guidance on Discussing this Topic with Patients

You could be LOSING $10,000's by NOT Knowing how to legally implement Cash-Pay Medicare programs in your practice ... Not to mention RISKING $10,000's if you get caught doing it wrong!

The Audio-Book

$97

The eBook

$147

The Recorded Webinar

$47

Get All 3 of these amazing products for the low price of $197 — (a $100 DISCOUNT!)

NOT SURE? SCROLL DOWN TO READ ABOUT YOUR BONUSES

BONUS! Over 20 Pages ofFrequently Asked Questions

There is ALSO a Q&A section (in the eBook and Audiobook) that answers all the other most common and obscure questions I've received on this topic over the past 5 years ...Helping Practice Owners make $1000's by Safelyaccepting Cash-Pay Medicare patients .Some of those questions include:

Want an Attorney to help guide you throughthese murkey legal waters? Great! You Should!BUTMost attorneys DON'T KNOW about thisobscure but vital part of Medicare Law.

Provide Your Attorney with a Guidebook that Directly Links toEvery Part of the Law They Will Needto Help You Make the Best Decisions ...

Saving them Time andSAVING YOU $1,000's IN LEGAL FEES

The Audio-Book

$97

The eBook

$147

The Recorded Webinar

$47

Get All 3 of these amazing products for the low price of $197 — (a $100 DISCOUNT!)

If you don't feel like these products are worth every penny you spent, I'll give you a full refund. No questions asked.

What Your Colleagues Are Saying AboutMedicare and Cash-Pay PT

Are you tired of having your documentation scrutinized and having to deal with the confusing and frustrating maze of Medicare regulations?

► Do you want to get out of the system so you can focus on patient care and growing your business rather than on paperwork?

► Maybe you'd just like to establish some cash-pay programs for your Medicare patients. Do you know how to do so in accordance with the law?

► Want the FREEDOM to treat your patients the way you know is best, and not have to worry about what will be reimbursed?

What Your Colleagues Are Saying AboutMedicare and Cash-Pay PT

It's Time to Stop Guessing and Hoping ...It's Time to Drop Confusion and Fear ...It's Time to Get Clear on How You Can Capitalize onEnormous Cash-Pay Opportunitiesand Keep your Practice Safe & Thriving!

The Audio-Book

$97

The eBook

$147

The Recorded Webinar

$47

Get All 3 of these amazing products for the low price of $197 — (a $100 DISCOUNT!)

Still not sure? Find answers to your questions below

Frequently Asked Questions

I usually don't spend more than $25 on a book. What makes this one different and worth more than that?

Does this eBook apply to related professions such as occupational therapy, speech pathology, chiropractic, or medicine?

I'm interested in having a cash-based practice someday, but it won't be for a while. Should I wait till I'm ready to start the practice before I buy this book and learn this information?

Shouldn't I be getting these answers from an attorney?

What's Your Plan for the Future?

The Audio-Book

$97

The eBook

$147

The Recorded Webinar

$47

Get All 3 of these amazing products for the low price of $197 — (a $100 DISCOUNT!)

100% MONEY BACK GUARANTEE - NO QUESTIONS ASKED

About the Author

Jarod Carter PT, DPT, MTC

Still not sure if you want to buy the eBook? Okay, but at least get the first 22 pages for free by clicking the button below...

[INSERT MAIN CHALLENGE SOLVED] The One BIGGEST CHALLENGE All Cash-Based Providers Must Overcome to Create Success

This Masterclass Will Answer All Of Those Questions And More!

Hear What The Attendees Had To Say About This Masterclass

Here’s what you get when you grab access today

The total value of everything included is $x

For Just

$47

Still on the fence? Here’s just some of what you'll learn inside when you join today

Not To Mention Practice Owners Absolutely Love These Masterclasses...

Lock In Your Seat Today for Just

$47

Ignorance of Medicare Laws on
Cash-Pay PT Services
Could Leave You Defenseless
AND Missing Huge Opportunities

The Vital Things You Will Learn
in Just the FIRST HALF of This eBook:

BONUS! Over 20 Pages of
Frequently Asked Questions

There is ALSO a Q&A section (in the eBook and Audiobook) that answers all the other most common and obscure questions I've received on this topic over the past 5 years ...
Helping Practice Owners make $1000's by Safely
accepting Cash-Pay Medicare patients .

Some of those questions include:

Want an Attorney to help guide you through
these murkey legal waters? Great! You Should!
BUT
Most attorneys DON'T KNOW about this
obscure but vital part of Medicare Law.

Provide Your Attorney with a Guidebook that Directly Links to
Every Part of the Law They Will Need
to Help You Make the Best Decisions ...

Saving them Time and
SAVING YOU $1,000's IN LEGAL FEES

What Your Colleagues Are Saying About
Medicare and Cash-Pay PT

What Your Colleagues Are Saying About
Medicare and Cash-Pay PT

It's Time to Stop Guessing and Hoping ...
It's Time to Drop Confusion and Fear ...
It's Time to Get Clear on How You Can Capitalize on
Enormous Cash-Pay Opportunities
and Keep your Practice Safe & Thriving!