Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other


Tom Kane, PT
MediGraph Software

Medicare as a Secondary Payer
3/27/2011 12:59:00 PM

The current financial climate is causing more Medicare beneficiaries to remain employed.  A major motivation for not retiring is because pension plans and home values (typical retirement  nest eggs) have been eroded.  As the level of economic uncertainty continues, the number of Medicare beneficiaries that remain employed is growing.  Therefore, we PTs must recognize that our payment may depend on the collection and coordination of health insurance  coverage from the patient.  Medicare can be a secondary payer when beneficiaries are covered by other insurance, including group health plans offered by employers (GHP).  Physical therapists must be certain to obtain all of the patients’ insurance information instead of assuming that Medicare is always primary.  If the primary payer is not Medicare, physical therapist must bill the primary payer before billing Medicare as required by the Social Security Act.



Primary Payers

Primary payers are those that are responsible for the first payment of a claim. Examples are unending but include the aforementioned group health plan (GHP) provided by the employer of a Medicare beneficiary.   Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. Medicare may also be the primary payer in some other instances.   For additional information, CMS provides  guidance at http://www.cms.gov/MLNProducts/downloads/MSP_Fact_Sheet.pdf. You may also verify Medicare's primary/secondary status by contacting the COBC at 800-999-1118.


Other Important Points of Interest

  1. Medicare sometimes pays for benefits that GHP denies or if the GHP has been exhausted.
  2. A signed plan of care remains a requirement if Medicare is not the primary.
  3. Medicare documentation requirements are required when Medicare is not the primary.
  4. The therapy cap remains in place.   If PT services exceed the cap, an exception must be obtained.
  5. When Medicare is not the primary your records remain vulnerable to RAC audits.


Best regards,

Tom Kane, PT

MediGraph Software