Practice Management Alert

Question: How do you bill patients for physical therapy/occupational therapy when they've met their limit?

Indiana Subscriber

Answer: If you're treating a patient who has a limit to the amount of therapy her insurance company will pay for, you simply have to start billing the patient directly once that limit is reached, says Cindy MacQuarrie, a reim-bursement specialist with BKD LLP in Kansas City, Mo.
 
Make sure someone in your practice alerts patients to any caps they're under when they first begin treatment, advises MacQuarrie. That way, they shouldn't be surprised down the line when you have to start billing them directly. Giving patients this notice isn't a requirement, as far as MacQuarrie can tell, but it's a good public relations measure, she says.
 
Also, send the patient a letter when they reach their limit explaining why you now must bill them. Sometimes, the patient will have supplementary insurance that will cover it. If not, the only way you'll get paid is by the patient, MacQuarrie points out.
 
Many providers are on pins and needles about the $1,590 therapy cap CMS is trying to institute for Medicare beneficiaries beginning in October, she notes. If this cap goes through as planned, many more providers will find themselves faced with patients with limited access to Medicare-reimbursable therapy. It's important for providers to keep in mind, though, that the Medicare cap wouldn't apply to therapy provided in the hospital's outpatient department. That means medical offices could bill for patients' therapy until they reach the cap and then send the patient to the hospital for any remaining therapy, postulates MacQuarrie.