Navigating Billing for Medical Exercise Services: MET 101 Tip #26

In the 26th tip from the MET 101 eBook series, Dr. Mike addresses a common question among physical therapists: "Can I bill for Medical Exercise (ME) Services?" This tip offers valuable guidance on how to properly structure and seek payment for these services once a patient has been discharged from physical therapy.

Key Points:

1. Distinguishing Patients from Clients:
• Dr. Mike emphasizes the importance of understanding the distinction between patients and clients. Once patients are discharged from physical therapy, they transition to being clients for MET services.
2. Billing for ME Services:
• Physical therapists can bill for MET services through a monthly membership model. It is crucial to communicate clearly with insurance carriers, clients, and referral sources that the services provided are not physical therapy but a structured exercise program.
• The billing should reflect a monthly membership fee rather than using CPT codes, which are typically associated with physical therapy services.
3. Insurance Carrier Considerations:
• Insurance carriers are generally supportive of medical memberships or aftercare programs, but they prefer these programs to have a defined duration, typically four to six months.
• Periodic reassessment and updates on the client’s progress are necessary to maintain transparency and effectiveness of the program.
4. Establishing Clear Protocols:
• Implementing a structured exercise program with clear protocols is essential. Regular communication with referral sources and obtaining proper referrals for aftercare programs can enhance the legitimacy and acceptance of ME services.
• Documentation and supervision by qualified rehab technicians can help ensure the program's success and client safety.
5. Real-World Example:
• Dr. Mike shares an example from his practice, where a structured aftercare program was successfully implemented for a client post-ACL reconstruction. This involved collaboration with a health club and continuous updates to both the therapist and the physician.

Conclusion: For physical therapists, billing for ME services is feasible and beneficial when done correctly. It involves transitioning discharged patients to clients, clear communication with insurance carriers, and maintaining structured and supervised exercise programs.

Get Your Free Copy: To explore more tips and insights, download your free copy of the eBook at www.met101ebook.com.

This blog post provides medical exercise professionals with practical advice on optimizing their billing practices for ME services, ensuring compliance, and enhancing client outcomes.