1. Insurance carriers will not reimburse you for post-rehab services. The truth is that insurance carriers will pay for post-rehab services if they feel the services are beneficial to the client, improve the client’s overall level of function and if the services are not used in the place of the services provided by a licensed physical therapist, chiropractor or physician. Post rehab services are not covered by Medicare and Medicaid. My article on the “5 Criteria for Post Rehab Insurance Reimbursement” explains this in detail.

2. A provider number is required to bill an insurance company and obtain insurance reimbursement. This is not necessarily accurate. The provider number is a number used to identify the practitioner as a member of the network and nothing more. It may make getting reimbursement a bit harder but the insurance carrier does not say that non-providers cannot receive re-imbursement. Obtaining pre-authorization for post-rehab services is the key. I would recommend that you approach the insurance company to become a provider if you have multiple fitness facilities. There is an application process for obtaining a provider number but fitness is becoming an integral part of the medical management of many conditions.

3. I can use the use a medical professional’s license to obtain insurance reimbursement for post-rehab services. This is absolutely not true and may constitute insurance fraud. The idea of billing for post-rehab services under a license of a physical therapist, chiropractor, physician and/or nurse is 100% illegal. If the medical professional does not actually provide the services, then it is illegal for he or she to bill that under their license number. If you contact the insurance company, explain your programs and the benefits of your programs, you may find the insurance carrier receptive paying you directly for post rehab services. Again, stay away using a medical professional’s license number; that is illegal.

4. I should bill just as much as the physical therapist and/or chiropractor charge. Please understand, insurance carriers keep track of every provider there is out there. From this standpoint, they’ve developed a profile on each medical provider in which they start to use these profiles to determine if someone is billing for outrageous treatments or billing for services that really shouldn’t be covered, or they’re excessively billing for services. Please understand, as a post-rehab professional, when you start to charge the exact same amount that chiropractor or physical therapist does, remember your services may not be as specialized. And, also, that’s not saying that a physical therapist or chiropractor is better, but when you’re billing at their same level, remember their overhead cost may be a little different, probably greater, and you also have to remember there’s a higher level of professionalism. I don’t mean that in a negative sense, but please understand, when you start trying to bill the same thing that the physician, chiropractor or physical therapist do, eventually the insurance carrier is going to adjust those charges such that you’re going to end up getting what they want you to receive rather than what you are asking for. So play fair with the insurance companies. I guarantee you in the long run you’ll be better off.

5. Working with seniors and getting insurance reimbursement for senior fitness services can make me a lot of money. The post-rehab service is not covered by Medicare and Medicare. A couple of groups in Arizona and Florida received reimbursement from Medicare for group-based fitness services, but after one or two payments, they denied any further claims. There are some carriers that are more receptive such as workman’s compensation carriers, motor vehicle accident carriers and some third-party carriers. Post rehab services will not be reimbursed by Medicare and Medicaid.

6. All I have to do is just simply send the insurance carrier my bill and I will get a check. You must contact the insurance carrier in advance to obtain pre-authorization for post rehab services. This means you will have to conduct an assessment, determine the exercise program and then contact the insurance carrier. The insurance wants to know how long, how often and how much, with regard to the post-rehab services. The idea of just simply submitting a bill and thinking the insurance carrier is going to pay you because the client has insurance coverage is not smart. Remember physicians, physical therapists, chiropractors, hospitals, surgical centers, all do the exact same thing, obtain pre-authorization for services and/or products. They don’t just simply submit a bill.

7. An insurance carrier only needs a copy of the workout card to approve reimbursement for post rehab services. Insurance carriers need detailed information. They want to know what was done, how it was beneficial to the client, and, most importantly, the outcome for the client. A copy of the workout card indicating sets and reps and the exercises performed is not the only documentation you need to present to the insurance carrier. You should provide a summary outlining the details of the session, the outcome of the session, the session goals and more importantly, a plan for future sessions. Just sending the insurance carrier a bill is not sufficient. You need to provide details to the insurance carrier to obtain reimbursement.

Now that we have discussed the seven myths of insurance reimbursement for post-rehab services, I invite you to visit our website to get more details on how to submit insurance claims and obtain insurance reimbursement for post rehab services. That website is www.postrehabtoday.com http://www.postrehabtoday.com. Click on the link for insurance reimbursement. This program will provide you with information regarding our insurance reimbursement program and will dismiss all the myths and mistaken beliefs about insurance reimbursement.

Learn more about Post Rehab or Medical Rehab Programs. Stop by Michael K. Jones, PhD, PT’s site where you can find out all about post rehab certifications and careers.