Hello everyone!! I hope this blog post finds you and yours safe and healthy. Covid – 19 has certainly turned our lives upside down. We are now seeing and will see even greater shifts in both the healthcare industry and fitness industry. The shutdown of health clubs and the restrictions with hospital elective surgeries has major implications for revenue and the future of these two industries.
The shift in the fitness industry is toward medical exercise and post rehab fitness. This is great for fitness professionals. But we must be careful. We are seeing a proliferation of post rehab certification programs. This is good as a means of giving access to more fitness professionals to obtain the necessary training to work with chronic medical conditions. But there is also concern with the marketing of these certifications. Many ads for these certification programs are using terms which should not be part of the language of medical exercise or post rehab professionals. These terms include “patient and treatment”. Let’s talk about these in the post.
These two terms along with multiple references to insurance reimbursement for medical exercise and post rehab services are being used to promote post rehab certifications. Let me take a few moments to offer some insight and clarity on the use of these terms as well as an understanding of the “Real Deal” in medical exercise and post rehab. Our 26 years of teaching the METI – Medical Exercise Specialist certification along with helping MESs build practices and connect with medical professionals allows me a unique insight on the current state and the future of medical exercise/post rehab training.
The use of the term “patient” by all fitness professionals is inappropriate. The use of “treatment” is also inappropriate. As a medical exercise/post rehab professional you are not providing medical treatment. Though many will say exercise is medicine, but in a non-clinical setting, it is simply exercise. Yes, exercise is beneficial to medical conditions, but when its offered in a non-clinical setting or fitness facility…..it is not treatment. Use of the term “treatment” elevates the fitness professional’s responsibility and liability to a much higher level than their training provides. Treatment moves into a different realm of care and management.
Medical professsionals, whether physical therapists, physicians, nurses, etc, provide treatment to “patients”. Patients receive treatment from medical professionals. Using the term “patient” indicates medical services are being provided. This again elevates the level of responsibility and liability to a much higher level of training than the fitness professional is prepared. Fitness professionals, if working in a non-clinical setting, you provide services to “clients”.
When we started the MES program in 1994, the idea of insurance reimbursement for medical exercise/post rehab services was non-existent. But now it is reality, but it is a “complicated reality”. Insurance reimbursement is not as simple as see a client, provide MET service and then bill the insurance carrier. The client must meet at least 5 criteria before you can even think of billing the insurance carrier. If the client meets the criteria, you still must provide documentation of services; have established goals for the post rehab program as well as contacting the carrier to obtain pre-authorization for payment of the services. The 5 criteria are:
The MET insurance reimbursement criteria are:
- Physician’s Referral
- Major Trauma, Surgery or Long-Term Condition
- Received Maximum Benefit from Physical Therapy, Chiropractic, etc
- Residual Functional Deficits
- Not Covered by Medicare, Medicaid or Govt Coverage
If the client meets ALL 5 criteria, then you may begin the process of submitting for reimbursement. As you can now see, insurance reimbursement is not for the faint of heart. It requires multiple phone calls to the insurance carrier as well as submission of progress reports to the physician and frequent follow-ups with the carrier. Again, insurance reimbursement for MET services is not an easy task. We have a number of METI – Medical Exercise Specialists that are now insurance providers. But they will tell you, insurance reimbursement is a complicated process.
There are a number of other concerns with the recent marekting of medical exercise/post rehab certification programs. The ones I have mentioned in this post are the most important but there are more. Please watch the video to review all the concerns. After your viewing please share your thoughts and points of view in the comments section of these blog.
Best wishes to you and yours. Stay safe and healthy and good luck with building your medical exercise/post rehab practice.