The world of insurance and, in particular Medicare, is rapidly changing. These changes are being made, even as you read this article; affecting not only Medicare as a whole, but the process through which your medical claims are documented and paid. It is extremely important that you work with a qualified physical therapist when it comes to obtaining approval and proper documentation to have your physical therapy covered.
It is also imperative that your physical therapist and their office know and follow all of these new regulations and procedures to ensure that your physical therapy is not only approved, but paid out to the fullest extent possible according to your particular medical insurance plan(s); thus, also helping to minimize your out of pocket expenses. The last thing you need is to be worrying about if your PT is covered by Medicare and any other insurance(s) you may have. Taking care of the paperwork is something that your PT Clinic should do for you; working with you every step of the way to let you know where you stand financially.
Here is some basic information to consider when utilizing the Medicare system:
Medicare patients must have a doctor’s prescription for physical therapy.
This prescription helps to determine the “necessity” of your physical therapy and will help to provide the needed documentation for both Medicare and any other insurance(s) you may have. Please remember that the limitations and determinations explained in this article are for Medicare only and do not include individual policies from HMOs, PPOs, and other insurance(s) that you may have. These additional policies can help deter monetary expenses and may require some alternative documentation.
Go Physical Therapy’s certified physical therapists and staff work with our patients to make sure they have a clear understanding of the most recent changes and challenges involved with the Medicare process. We help our patient’s with their Medicare paperwork quickly and accurately, in order for them to receive the maximum benefits allowed when they need them most.
Listed below are the 2013 Physical Therapy “caps” for Medicare patients:
- $1,900 total for physical therapy/speech therapy services combined
- $1,900 total for occupational therapy services
This is for Medicare only and does not include allowances if you should carry other insurances or payers for your medical expenses. See our form explaining some of the limits and expectations for Medicare patients here. This form can help explain some questions regarding Medicare options.
What If I Need More Than the Set Limits for PT?
You can qualify for additional funding for physical therapy with proper documentation justifying your medical need for extended services. I make sure that both I and my entire staff are knowledgeable in Medicare policies in order to help clients qualify for additional benefits when medically necessary. Our everyday documentation process ensures precise information, which may be needed to provide medical necessity for extended services. The proper documentation can help in getting Medicare to approve expenses above the $1,900 limit (up to $3,700 in each category listed above) without you having to pay for these additional expenses. Remember that every case is individual & unique. This is why it is so very important to have an expert on your side. Go Physical Therapy deals with Medicare daily and we know what is required to ensure that you get the maximum benefits possible when it comes to receiving the physical therapy you need.
It is important that you feel comfortable in knowing that your therapist and their office staff understand the Medicare system; keeping up with its many changes. You, as a patient, should never have to worry about where you stand as far as the payment process and changes happening with Medicare services. I think it’s important to remove any doubt or fears from your mind so that you can concentrate on your individual goals and living a pain-free life.
Dedicated To Your Health & Well-being,