Are you a postrehabologist who has clients with insurance coverage? Not sure how to contact the insurance company? Have you been denied an insurance claim because you weren’t sure what to do? You may not be sure what insurance companies will cover. There are several myths about insurance reimbursement for post-rehabilitation services, here are the top 7 myths we hear frequently:
Myth #1: Insurance companies won’t pay for post-rehab services. In reality, we found that insurance companies they are open to the idea of paying for post-rehabilitation services, Yeah they feel the services will benefit the client, improve the client’s general level of functioning, and the services are not used in lieu of services provided by a licensed physical therapist, chiropractor, or physician. Medicare and Medicaid will not pay for post-rehabilitation services.
Myth #2: I need a provider number to bill an insurance company for insurance reimbursement. This is not necessarily true. The provider number is nothing more than a number used to identify the doctor as a member of the network. The insurance company does not say that non-providers cannot be reimbursed; it just makes it a little more difficult. The key is to get prior authorization for post-rehab services. If you have multiple fitness facilities, I would recommend that 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 get insurance reimbursement for post-rehabilitation services. This is absolutely false and may constitute insurance fraud. The idea of billing for post-rehabilitation services under the license of a physical therapist, chiropractor, doctor and/or nurse is 100% illegal. If the medical professional does not actually provide the services, then it is illegal for them to bill for that with their license number. If you contact the insurance company, explain their programs and the benefits of their programs, the insurance company may be willing to pay you directly for post-rehabilitation services. Again, steer clear of using a medical professional’s license number; that’s illegal
Myth #4: I should bill as much as the physical therapist and/or chiropractor charges. Please understand that insurance companies keep track of every provider out there. From this point of view, they have developed a profile of each medical provider where they begin to use these profiles to determine if someone is billing for outrageous treatments or billing for services that really shouldn’t be covered, or is overbilling. services. Please understand that as a post-rehab professional, when you start charging the exact same amount that a chiropractor or physical therapist charges, keep in mind that their services may not be as specialized. And also, that’s not to say that a physical therapist or a chiropractor is better, but when you’re billing at the same level, remember that your overall costs may be a little different, probably higher, and you also have to remember that there’s a higher level. of professionalism. I don’t mean that in a negative sense, but understand, when you start trying to bill the same as the doctor, chiropractor, or physical therapist, eventually the insurance company will adjust those charges in such a way that you end up getting what they want you to receive in instead of what you are asking for. So play fair with the insurance companies. I guarantee you’ll be better in the long run.
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-rehabilitation services. In the past, a couple of groups in Arizona and Florida have been reimbursed by Medicare for group fitness services, but after one or two payments, Medicare files additional claims. Workers’ compensation insurers, auto accident insurers, and some third-party insurers are more receptive. Medicare and Medicaid will not pay for post-rehabilitation services at all.
Myth #6: All I have to do is simply submit my bill to the insurance company and I will receive a check. You must contact the insurance company in advance to obtain prior authorization for post-rehabilitation services. This means you’ll need to get an evaluation done, determine your exercise program, and then contact your insurance company. The insurance wants to know how long, how often, and how much, regarding post-rehabilitation services. The idea of simply sending a bill and thinking that the insurance company is going to pay you because the customer has insurance coverage is not smart. Remember doctors, physical therapists, chiropractors, hospitals, surgical centers, they all do exactly the same thing, obtain pre-authorization of services and/or products. They don’t just send an invoice.
Myth #7: The only documentation an insurance company needs for reimbursement is a copy of the training card. The insurance company needs to know what was done, how it was beneficial to the client, and most importantly, the outcome. You must provide more than just the training card that indicates sets and repetitions and the exercises performed. You should describe the details of the session, the outcome of the session, the objectives of the session, and most importantly, the plan for what will be done in subsequent sessions. So it’s not just the idea of sending a bill to the insurance company. In order to get reimbursed, the insurance company needs some details.
These are our top seven (7) myths about insurance reimbursement for post-rehabilitation services. We invite you to learn more about filing insurance claims and obtaining insurance reimbursement for post-rehabilitation services by visiting our website and clicking the Insurance Reimbursement link. We guarantee that the information provided in our insurance reimbursement program will dispel all the myths and misconceptions about post-rehab insurance reimbursement.
