Top Post Rehab Reimbursement Myths PDF Print E-mail
Written by Michael Jones   
Saturday, 02 October 2010 16:19
1. Insurance carriers won't pay for post-rehab services. Actually, we find that insurance carriers are open to the idea of paying for post-rehab services if they feel the services will benefit the client, improve the client's overall level of function and the services are not used in lieu of the services provided by a licensed physical therapist, chiropractor or physician. Medicare and Medicaid will not pay for post rehab services. See my article on the "5 Criteria for Post Rehab Insurance Reimbursement" for more details.
by MichaelJones


1. Insurance carriers won't pay for post-rehab services. Actually, we find that insurance carriers are open to the idea of paying for post-rehab services if they feel the services will benefit the client, improve the client's overall level of function and the services are not used in lieu of the services provided by a licensed physical therapist, chiropractor or physician. Medicare and Medicaid will not pay for post rehab services. See my article on the "5 Criteria for Post Rehab Insurance Reimbursement" for more details.

2. I need a provider number to bill an insurance company and obtain insurance reimbursement. This isn't necessarily true. The provider number is nothing more than a number used to identify the practitioner as a member of the network. The insurance carrier doesn't say that non-providers can't receive re-imbursement; it just makes it a bit harder. The key is to obtain pre-authorization for post-rehab services. If you do have multiple fitness facilities, I would recommend you approach the insurance company to become a provider. There is an application process but fitness is becoming a integral part of the medical management of many conditions.

3. I can use the use a medical professional's license to obtain insurance reimbursement for post-rehab services. This is absolutely not true and may constitute insurance fraud. The idea of billing for post-rehab services under a license of a physical therapist, chiropractor, physician and/or nurse is 100% illegal. If the medical professional does not actually provide the services, then it is illegal for he or she to bill that under their license number. If you contact the insurance company, explain your programs and the benefits of your programs, you may find the insurance carrier receptive paying you directly for post rehab services. Again, stay away using a medical professional's license number; that is illegal.

4. If the physical therapist and/or chiropractor charge a certain amount I should be able to charge the same. Every provider out there is tracked by the insurance carriers. The insurance carrier has developed a profile on each medical provider that they use to determine if a provider is billing for extreme treatments or billing for services that should not be covered. They also use this profile to determine if a provider is excessively billing for services. You need to understand, as a post-rehab professional, that a chiropractor or physical therapist services may be more specialized than yours before you start to charge the exact same amount. A physical therapist or chiropractor is not better than a post rehab specialist but remember their overhead cost may be a little different, probably greater, and there's a higher level of professionalism, and take that into consideration when you're attempting to bill at their same level. When you try to bill the same thing that the physician, chiropractor or physical therapist do, the insurance carrier may adjust those charges to give you what they want you to receive rather than what you are asking for. Play fair with the insurance companies. In the long run you'll be better off.

5. Working with seniors and getting insurance reimbursement for senior fitness services can be very profitable. Medicare and Medicare will not approve reimbursement for post-rehab services. In the past, a couple of groups in Arizona and Florida received reimbursement from Medicare for a group-based fitness services, but Medicare denied any further claims after one or two payments. Carriers that are more receptive to post rehab service reimbursement would be workman's compensation carriers, motor vehicle accident carriers, and some third-party carriers. Reimbursement is not possible from Medicare and Medicaid for post rehab services.

6. All that is required to receive my reimbursement check is to just simply send the insurance carrier my bill. A pre-authorization by the insurance carrier is necessary for post rehab services. This means that you will contact the insurance carrier only after you have conducted an assessment and determined the exercise program for that client. The insurance carrier will need a summary letting them know how long, how often and how much, with regard to the post-rehab services. Believing that all you have to do is submit a bill to the insurance carrier to receive reimbursement just because the client has insurance coverage is not very smart. Remember physicians, physical therapists, chiropractors, hospitals, surgical centers, all have to obtain pre-authorization for services and/or products. It requires more than simply submitting a bill to the insurance carrier.

7. The only documentation an insurance carrier needs for reimbursement is a copy of the workout card. The insurance carrier needs to know what was done, how it was beneficial to the client, and, most importantly, the outcome. You must provide more than simply the workout card indicating sets and reps and the exercises performed. You need to outline the details of the session, the outcome of the session, the session goals, and, more importantly, the plan of what will be done in the subsequent sessions. So it's not simply the idea of just sending the insurance carrier a bill. To obtain reimbursement the insurance carrier needs some details.

I have provided you with the seven myths of insurance reimbursement for post-rehab services. Should you want more details on how to submit insurance claims and obtain insurance reimbursement for post rehab services I invite you to visit our website at www.postrehabtoday.com http://www.postrehabtoday.com and click on the link for insurance reimbursement. This program will provide you with information regarding our insurance reimbursement program and will dismiss all the myths and misconceptions about insurance reimbursement.

DISCLAIMER: This article is provided as information only and is not to be taken as financial advice.

Learn more about Post Rehab or Medical Rehab Programs. Stop by Michael K. Jones, PhD, PT's site where you can find out all about post rehab certifications and careers. Free reprint avaialable from: Top Post Rehab Reimbursement Myths.