The Seven Myths About Insurance Reimbursement for Post-Rehab Services
Are you a PostRehabologist who has clients with insurance coverage? Are you not sure how to contact the insurance company? You have had an insurance claim denied because you were not sure what to do. Maybe you’re just not sure what insurance companies will reimburse. There are several myths about insurance reimbursement for Post-Rehab Services, here are the top 7 myths we often hear:
Myth #1: Insurance carriers won’t pay for post-rehab services. 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 instead of the services provided by a licensed physical therapist, chiropractor, or physician. Medicare and Medicaid will not pay for post-rehab services.
Myth #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 reimbursement; 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 an integral part of the medical management of many conditions.
Myth #3: I can use a medical professional’s license to obtain insurance reimbursement for post-rehab services. This is 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 provide the services, then it is illegal for him or her to bill that under their license number.
If you contact the insurance company and explain your programs and the benefits of your programs, you may find the insurance carrier receptive to paying you directly for post-rehab services. Again, stay away from using a medical professional’s license number; that is illegal.
Myth #4: I should bill just as much as the physical therapist and/or chiropractor charge. Please understand, that insurance carrier keep track of every provider there is out there. From this standpoint, they’ve developed a profile on each medical provider and they start to use these profiles to determine if someone is billing for outrageous treatments or billing for services that really shouldn’t be covered, or they’re excessively billing for services.
Please understand, as a post-rehab professional, that when you start to charge the same amount that a chiropractor or physical therapist does, remember your services may not be as specialized. And, also, that’s not saying that a physical therapist or chiropractor is better, but when you’re billing at their same level, remember their overhead cost may be a little different, probably greater, and you also have to remember there’s a higher level of professionalism.
I don’t mean that in a negative sense, but please understand, when you start trying to bill the same thing that the physician, chiropractor, or physical therapist do, eventually the insurance carrier is going to adjust those charges such that you’re going to end up getting what they want you to receive rather than what you are asking for. So play fair with the insurance companies. I guarantee you that in the long run, you’ll be better off.
Myth #5: I can make a lot of money working with seniors and getting insurance reimbursement for senior fitness services. Medicare and Medicaid will not pay for post-rehab services. In the past, a couple of groups in Arizona and Florida have received reimbursement from Medicare for group-based fitness services, but after one or two payments, Medicare any further claims. Workman’s compensation carriers, motor vehicle accident carriers, and some third-party carriers are more receptive. Medicare and Medicaid absolutely will not pay for post-rehab services.
Myth #6: All I have to do is just simply send the insurance carrier my bill and I will get a check. You must contact the insurance carrier in advance to obtain pre-authorization for post-rehab services. This means you will have to conduct an assessment, determine the exercise program and then contact the insurance carrier. The insurance wants to know how long, how often and how much, about the post-rehab services.
The idea of just simply submitting a bill and thinking the insurance carrier is going to pay you because the client has insurance coverage is not smart. Remember physicians, physical therapists, chiropractors, hospitals, and surgical centers, all do the same thing, obtain pre-authorization for services and/or products. They don’t just simply submit a bill.
Myth #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.
These are our top seven (7) myths of insurance reimbursement for post-rehab services. We invite you to get more details on how to submit insurance claims and obtain insurance reimbursement for post-rehab services by visiting our website and clicking on the Insurance Reimbursement link. We guarantee the information provided in our insurance reimbursement program will dismiss all the myths and misconceptions about post-rehab insurance reimbursement.
