The seven myths about insurance reimbursement for post-rehabilitation services

Are you a PostRehabologist who has clients with insurance coverage? Don’t know how to contact the insurance company? Was your insurance claim rejected because you weren’t sure what to do? Maybe you just don’t know what the insurers reimburse. There are several myths about insurance reimbursement for post-rehabilitation services, here are the top 7 myths we often hear:

Myth #1: Insurance companies don’t pay for post-rehab services. Actually, we think that insurance companies are open to the idea of ​​paying for post-rehabilitation services, if they believe the services will benefit the client, improve the client’s general level of functioning, and that the services are not used in place of those provided by a licensed physical therapist, chiropractor, or physician. Medicare and Medicaid do not pay for post-rehab services.

Myth #2: I need a provider number to bill an insurance company and get reimbursed. This is not necessarily true. The provider number is nothing more than a number used to identify the handler as a member of the network. The insurer does not say that non-providers cannot receive compensation; it just makes it a bit more difficult. The key is to obtain pre-authorization for post-rehabilitation services. If you do have multiple fitness facilities, I recommend approaching the insurance company to become a provider. There is an application process, but fitness is becoming an integral part of the medical treatment of many conditions.

Myth #3: I can use a medical professional’s license to get insurance reimbursement for post-rehab services. This is absolutely not true and could be insurance fraud. The idea of ​​billing post-rehabilitation services licensed by a physical therapist, chiropractor, doctor and/or nurse is 100% illegal. If the medical professional does not actually provide the services, it is illegal for him or her to bill for it under their license number. If you contact the insurance company, explain your programs and the benefits of your programs, the insurance company may pay you directly for post-rehab services. Again, stay away from 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 for each medical provider in which they will use these profiles to determine if someone is billing excessive treatments or billing services that shouldn’t be covered, or if they are billing excessively. Services. Please understand, as a post-rehab professional, when you start charging the exact same amount as a chiropractor or physical therapist, remember that your services may not be as specialized. And that’s not to say that a physiotherapist or chiropractor is better either, but if you’re billing at the same level, remember that their overheads may be a little bit different, probably higher, and you should also remember that there’s a higher level of professionalism. I don’t mean that in a negative sense, but please understand that when you try to bill the same as the doctor, chiropractor, or physical therapist, ultimately the insurance company will adjust those charges so that you’re going to end up getting what they want you to receive rather than where you ask for. So play fair with the insurance companies. I guarantee you will be better off in the long run.

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Myth #5: I can make a lot of money working with seniors and getting paid for senior fitness services. Medicare and Medicaid do not pay for post-rehab services. In the past, a number of groups in Arizona and Florida have received reimbursement from Medicare for group fitness services, but after one or two payments, Medicare has made no further claims. Workman compensation carriers, motor vehicle accident carriers, and some third-party carriers are more receptive. Medicare and Medicaid absolutely do not pay for post-rehab services.

Myth #6: All I have to do is just send the insurance company my bill and I get a check. You must contact the insurance company in advance to obtain pre-authorization for post-rehabilitation services. This means that you must do an assessment, determine the exercise program and then contact the insurer. The insurance company wants to know how long, how often and how much, with regard to aftercare. The idea of ​​simply filing a bill and thinking that the insurance company is going to pay you because the customer is insured is not a smart one. Remember that doctors, physiotherapists, chiropractors, hospitals, surgical centers all do exactly the same thing, obtain pre-authorization for services and/or products. They don’t just file a bill.

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 benefited the customer and, most importantly, the outcome. You need to provide more than just the workout chart that lists 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, most importantly, the plan of what will happen in the following sessions. It is therefore not just the intention to simply send the insurer an invoice. In order to receive compensation, the insurance company needs some information.

Here are our top seven (7) insurance reimbursement myths for post-rehab services. We invite you to learn more about making 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 in our insurance reimbursement program will debunk all myths and misconceptions about post-rehabilitation insurance reimbursement.