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 sets, here are the top 7 myths we often hear:
Myth #1: Insurance carriers won’t pay for post-rehab sets. truly, we find that insurance carriers are open to the idea of paying for post-rehab sets, if they feel the sets will assistance the client, enhance the client’s overall level of function and the sets are not used in lieu of the sets provided by a licensed physical therapist, chiropractor or physician. Medicare and Medicaid will not pay for post rehab sets.
Myth #2: I need a provider number to bill an insurance company and acquire insurance reimbursement. This isn’t necessarily true. The provider number is nothing more than a number used to clarify 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 meaningful is to acquire pre-authorization for post-rehab sets. If you do have multiple fitness facilities, I would recommend you approach the insurance company to become a provider. There is an application course of action but fitness is becoming a integral part of the medical management of many conditions.
Myth #3: I can use the use a medical specialized’s license to acquire insurance reimbursement for post-rehab sets. This is absolutely not true, and may constitute insurance fraud. The idea of billing for post-rehab sets under a license of a physical therapist, chiropractor, physician and/or nurse is 100% illegal. If the medical specialized does not truly provide the sets, 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 sets. Again, stay away using a medical specialized’s license number; that is illegal.
Myth #4: I should bill just as much as the physical therapist and/or chiropractor charge. Please understand, insurance carriers keep track of every provider there is out there. From this standpoint, they’ve developed a profile on each medical provider in which they start to use these profiles to determine if someone is billing for outrageous treatments or billing for sets that really shouldn’t be covered, or they’re excessively billing for sets. Please understand, as a post-rehab specialized, when you start to charge the exact same amount that chiropractor or physical therapist does, remember your sets 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 average 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, ultimately the insurance carrier is going to adjust those charges such that you’re going to end up getting what they want you to receive instead of what you are asking for. So play fair with the insurance companies. I guarantee you 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 sets. Medicare and Medicaid will not pay for post-rehab sets. In the past, a associate of groups in Arizona and Florida have received reimbursement from Medicare for group-based fitness sets, but after one or two payments, Medicare any further claims. Workman’s compensation carriers, motor means accident carriers, and some third-party carriers are more receptive. Medicare and Medicaid absolutely will not pay for post rehab sets.
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 improvement to acquire pre-authorization for post rehab sets. This method 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, with regard to the post-rehab sets. 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, surgical centers, all do the exact same thing, acquire pre-authorization for sets 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 advantageous to the client, and, most importantly, the outcome. You must provide more than simply the workout card suggesting 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 later sessions. So it’s not simply the idea of just sending the insurance carrier a bill. To acquire reimbursement the insurance carrier needs some details.
These are our top seven (7) myths of insurance reimbursement for post-rehab sets. We invite you to get more details on how to submit insurance claims and acquire insurance reimbursement for post rehab sets at by visiting our website and clicking on 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.