Eli's Rehab Report

Published on Wed Mar 26, 2008 PDF

Question: I work in an outpatient sports medicine and dance rehabilitation facility. We're finding that some third-party payers are paying for running injuries, and some are not. Do you have any billing advice for a patient who runs for fitness or recreationally and has an injury that has taken him away from his running?

Georgia Subscriber

Answer: Many payers do not knowingly reimburse for therapy services that support recreational activities such as sports and running. So it's surprising that you've actually found some that are paying. You should consider if the payer really knows what it's paying for. Has it reviewed those records, or are you simply submitting the claim and getting paid?

You may find that once payers see the records, they discontinue reimbursement. That said, you should contact the insurance payer to verify if recreational activities such as running are covered and if not, ask patients to pay cash up- front and then offer them the option of submitting the claim to their insurance company.

If for some reason running helps alleviate medical problems for a patient, you may have a shot at reimbursement. For instance, does the exercise help keep his blood pressure under control? But for the most part, once the patient can function and do his basic ADLs, running is generally not covered by payers.