Eli's Rehab Report

Published on Sat Jun 20, 2009 PDF

Question: In the last issue, I read the article about how therapists cant opt out of Medicare, but that they can  be non-participating. Im in a practice that specializes in sports medicine, and we dont accept Medicare patients. So were not even non-participating. Is this OK?

Georgia subscriber

Answer: There is no rule that says youre obligated to enroll as a Medicare provider and accept Medicare beneficiaries.

However, be careful that you dont unknowingly treat a Medicare patient.

Before the initial visit, find out if the patient is eligible for Medicare. If she is, explain that you are not enrolled as a Medicare provider and therefore cannot file for her reimbursement, nor can she file for her own Medicare reimbursement (since youre not even non-par, for which you still have to be enrolled in the program). Make sure you also explain that by law, you cannot privately contract with her either.

Exception: If all youre planning to do is provide a completely non-covered service, then you can work with the patient. For example, since youre in a sports medicine practice, you might get a healthy Medicare beneficiary who wants to improve his golf swing. This would not be covered by Medicare since the Medicare program does not reimburse for therapy services solely for recreational purposes, so you could treat the patient. They would pay you in cash, of course. And make sure they dont submit a bill to Medicare themselves.

To be ethically sound, have a list handy of other therapy providers in the area you can refer Medicare patients to so they can receive treatment in a timely manner.

--  Reader questions were reviewed by Rick Gawenda, PT, director of PM&R at Detroit Receiving Hospital and President/CEO of Gawenda Seminars.