Today’s blog post comes from Ann Wendel, PT. Ann is the owner of PranaPT, a member of WebPT, and an active social media participant (@PranaPT). Thanks, Ann!

Due to all of the recent changes in Medicare documentation and billing requirements, I have had an increase in the number of questions from other physical therapists regarding cash-based services for Medicare patients.

In past articles, I have discussed the inability of physical therapists to “opt out” of Medicare (here and here). Today, though, I want to discuss the provision of wellness services on a cash-pay basis for Medicare-age clients.

I have not been able to find a detailed definition of what constitutes “wellness services” for Medicare patients; however, the general consensus among those of us who are cash-based providers is that we provide wellness services when we are not treating a specific injury, pain, or dysfunction and we are maintaining a level of fitness/strength and/or we are preventing falls or decline of health. Jarod Carter does a great job of explaining this here.

Wellness services are most appropriate for those patients who will benefit from supervised exercise, movement, and balance training for overall health. These may include patients who are ready for discharge from formal physical therapy due to meeting goals or patients who would like the guidance of a physical therapist for a generalized exercise program.

Based on the interests and certifications of the therapists in your clinic (or contractors that you bring in), examples of cash-based services can include:

  • Pilates Mat and Reformer sessions
  • Weight training with either free weights or machines
  • Kettlebell training
  • High-level balance training activities
  • Falls prevention workshops
  • Tai Chi classes
  • Yoga classes
  • Aquatic therapy

You can price services at whatever the market supports in your area. I suggest looking at the average price of a session with a sought after local personal trainer and then pricing up a bit from there. Patients can pay per session or buy a package of five or ten visits.

Before you add cash-based wellness services, you will want to review your liability policy to be sure that services other than “physical therapy” are covered. You may also want to ask Medicare patients to sign an ABN if your compliance expert recommends that you do so.

As a large part of the US population reaches Medicare age, physical therapists should be ready to step in to meet the wellness needs of those in our local communities. We have an excellent understanding of general medical conditions, medications, and surgical procedures which helps us to develop appropriate exercise programs for seniors. With a bit of creativity, we can continue to help this patient population meet their fitness and health goals even after discharge from physical therapy.

Have you added any cash-based services for Medicare-age clients in your clinic? I would love to hear what others are doing!

The 2018 Rehab Therapy Salary Guide - Regular BannerThe 2018 Rehab Therapy Salary Guide - Small Banner
  • PT in the House: 6 Benefits of Running a Home-Visit Therapy Practice Image

    articleOct 20, 2017 | 7 min. read

    PT in the House: 6 Benefits of Running a Home-Visit Therapy Practice

    What if I told you there’s a physical therapy practice model that requires minimal investment, has a low operating cost, and is practically burnout-proof? What if I added that this model provides a steady flow of new clients and is well poised to meet the rehab needs of the Baby Boomer generation? It would almost be too good to be true, right? Well, this model exists, and since 2009, my partners and I have enjoyed all of …

  • Common Questions from Our Cash-Based Physical Therapy Webinar Image

    articleAug 30, 2017 | 19 min. read

    Common Questions from Our Cash-Based Physical Therapy Webinar

    Earlier this week, WebPT’s president and co-founder, Dr. Heidi Jannenga, PT, DPT, ATC/L, teamed up with cash-based physical therapy guru Dr. Jarod Carter, PT, DPT, MTC, to host a webinar covering all things cash pay —from insurance contracting considerations and Medicare rules to self-referral marketing and service pricing. Thousands of rehab therapy professionals registered to attend, which means we received a ton of questions—so many, in fact, that there was no way we could answer all of …

  • Should Physical Therapists Enroll as Medicare Providers? Image

    articleJul 8, 2014 | 9 min. read

    Should Physical Therapists Enroll as Medicare Providers?

    If you’re starting—or have ever started—a private physical therapy practice, then you’ve almost certainly grappled with the decision of whether to accept Medicare patients. And unless your patient demographic absolutely demands that you do, I’m guessing it is—or was—a pretty tough call to make. I’ll be upfront: the title of this post is perhaps a bit misleading, because honestly, there is no one-size-fits-all answer to this question. As such, I can’t, in good conscience, definitively tell you …

  • Cashing In on Private Pay: The PT's Guide to Going Out-of-Network Image

    webinarJul 27, 2017

    Cashing In on Private Pay: The PT's Guide to Going Out-of-Network

    For many rehab therapists, submitting a claim to a third-party payer feels a lot like pulling the lever on a slot machine. You never know for sure what you’re gonna get—and most of the time, it’s less than you’d hoped for. With seemingly ever-increasing regulations—and constantly shrinking reimbursements—it’s no wonder so many PTs, OTs, and SLPs feel like the financial odds are stacked against them. [video://fast.wistia.net/embed/iframe/c49leax8yk] As a result, more and more rehab therapy providers are trying …

  • What to Look for in a PT Biller Image

    articleJul 28, 2015 | 4 min. read

    What to Look for in a PT Biller

    In the words of American rock legend Tom Petty, “Good love is hard to find.” While I agree wholeheartedly with Mr. Petty’s wisdom, I think some rehab therapy practice owners might say good employees are even harder to find. And that certainly applies in the billing department. After all, your clinic’s billing operation is crucial to its financial well-being. One bad hire could mean the difference between your clinic achieving private practice rockstardom and hitting rock bottom. …

  • Dipping a Toe into the Out-of-Network Waters: The ActivCore Model Image

    articleJan 6, 2016 | 9 min. read

    Dipping a Toe into the Out-of-Network Waters: The ActivCore Model

    As regulations intensify, reimbursements dwindle, and patients take greater control of their health care, interest in cash-pay services and cash-based practice models has increased, especially among physical therapists. For years, we here at WebPT have kept a pulse on the cash trend, sharing hard-hitting pieces by Ann Wendel and Jarod Carter. Recently, we discovered a new out-of-network model—one that’s complementary to the in-network model most practices already have. This setup allows providers to dip their proverbial toes …

  • The Psychology of the Cash-Pay Patient Image

    articleAug 16, 2017 | 8 min. read

    The Psychology of the Cash-Pay Patient

    For the past few years, I’ve been selecting healthcare providers based on the quality of care I believe I’ll receive—whether or not they accept my insurance. And more often than not, the providers I choose are out-of-network or cash-based providers , which means I happily hand over my credit card to pay the full cost of my care at the point-of-service. Now, in some cases, the provider has handed me a superbill to submit to my insurance …

  • Direct Access in Action: Jennifer Gamboa of Body Dynamics, Inc. Image

    articleOct 27, 2014 | 5 min. read

    Direct Access in Action: Jennifer Gamboa of Body Dynamics, Inc.

    In many cases, the old retail axiom “you get what you pay for” holds true within the healthcare market as well—and that is precisely why Jennifer Gamboa, DPT, OCS, MTC, and president of Body Dynamics, Inc. , believes that more physical therapy practices should be looking beyond the third-party payer game as they develop their business models. The way Jennifer sees it, declining reimbursement rates not only threaten the survival of private practice physical therapy clinics, but …

  • Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans Image

    webinarFeb 23, 2017

    Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans

    Copayments, coinsurances, unresolved balances—oh my! Any one of these can cause headaches for healthcare providers, but as healthcare reform efforts shift more and more financial burden to insurance beneficiaries, today’s practitioners are increasingly facing all three. And these challenges are not only hurting their patient acquisition and retention rates, but also their bottom lines. Tired of spending time verifying benefits only to lose those patients to copay sticker shock? Stuck in a constant cycle of pursuing past-due …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.