Review these practical steps that can be somewhat unique when providing cash-based services for an annual checkup by a physical therapist.
- Start by reviewing the Annual Checkup by a Physical Therapist webpage
Become familiar with other guidelines, regulations, and issues that should be considered when providing this service to your patients and clients.
- Determine Target Market(s) for the Service
The population you approach first likely will depend on your current patient population. In most settings it may make sense to start with your discharged patients, and their friends and families. Other options are geriatric populations including those from senior centers and senior living communities, and individuals with physical disabilities in the community. The latter group may be harder to identify or access within your own patient or client population, but local community service agencies and resources may be a good place to begin to understand how best to market your service to these individuals.
- Fee Determination
In establishing a cash-based service, your practice determines the value of the service and establishes the fee. As always, you must know your costs in order to determine your fees. While APTA can’t help members with setting fees, you might get help from a business or consulting service.
- Establish Policies and Procedures for Fee Collection
Develop a written policy to inform your staff and your patients and clients when out-of-pocket fees are to be collected. Typically practices prefer to collect fees as a part of the checkout process, but you may choose to collect payment at check-in.
During the checkup you could identify condition(s) that require additional physical therapist services or referral to another professional for consultation before you continue. A written policy should be in place regarding whether a reduced fee or no fee will be collected if you do not complete a full checkup. Use your professional judgment and consider how the physical therapist service is structured to determine if a full physical therapist examination and evaluation for the identified condition(s) can be carried out at that time and if the examination and evaluation would then be reimbursable under the client’s health plan benefit.
- Role of Insurance
An annual physical therapist checkup is not routinely reimbursed by third-payer payers. You need to consider the policies of the approved payers when providing a noncovered service to their beneficiaries. Physical therapists with in-network or participating provider relationships with private payers should understand and comply with the policies of each individual payer. Learn more.
If you provide the annual checkup to Medicare beneficiaries, have them complete and sign an Advanced Beneficiary Notice (ABN) prior to the annual checkup. Medicare will most likely deny payment for the service because it is not considered reasonable and necessary under Medicare program standards. Review the ABN form and additional information on the use of an ABN. Similarly, it is a good idea to have non-Medicare clients sign a release in advance of the annual checkup, as most health plans will not reimburse for wellness services.