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