For many fitness professionals entering the post rehab and medical exercise market, their first question is, “can I receive insurance reimbursement for providing post rehab services”? Well, the answer is yes, but there is a “post rehab ideal client scenario” that makes the possibility of reimbursement much greater. The “ideal post rehab scenario” and/or “post rehab insurance reimbursement criteria” is outlined below.
The key for post rehab professionals is understanding the insurance reimbursement maze and being able to identify the client scenario that offers the best chance for reimbursement. There is an “ideal post rehab scenario” that is usually reimbursed to some degree by the insurance carrier. We have titled this the “Post Rehab Insurance Reimbursement Criteria”. It is as follows:
1) The client must have insurance coverage through a workman’s compensation, motor vehicle accident claim or have a third party insurance carrier such as Blue Cross/Shield, ATENA or Connecticut General (these are just examples) .
2) The client must have sustained a traumatic injury and/or underwent surgery. Example of this would be a client with a ruptured anterior cruciate ligament in the knee or a disc herniation in the lumbar spine either of which has surgery to correct the injury. These clients need long-term supervised exercise after the completion of physical therapy or chiropractic care is done.
3) The client must have residual functional deficits that are present after the client has completed physical therapy and/or chiropractic care. At some point the client no longer needs PT or chiropractic but there are still functional deficits that impair the client’s function. These include functional limits in ROM/flexibility, strength, power, endurance, balance, proprioception, joint stability, muscle recruitment and coordination. The post rehab exercise program addresses these deficits after discharge from physical therapy.
4) The client has a signed referral from his or her physician or physical therapist requesting a supervised functional conditioning program.
5) The client has received the maximum benefit from physical therapy and chiropractic care. The client has been through a course of physical therapy and/or chiropractic and reached the maximum level of function with these services and now is discharged. The client must be seen by a licensed medical professional prior to referral for post rehab services. This ensures the proper care and treatment are delivered in the acute and subacute stages following the injury.
The process of insurance reimbursement for post rehab services is more complicated then simply holding a post rehab certification such as the “Medical Exercise Specialist”. I must admit we never thought we would see MES’ or PRCS’ receiving insurance reimbursement. Your best chances for reimbursement are far greater when working with clients that meet criteria. As you can see, the post rehab reimbursement criteria encompasses a wide range of clients. Medicare and Medicaid will not reimburse for post rehab services.
Click the link below and listen to my explanation of the post rehab criteria. We also have an audio-based workshop titled “Insurance Reimbursement for the Post Rehab Professional” that discusses the process and procedures for securing insurance reimbursement. The course takes you step by step through the insurance reimbursement process. For more information visit www.postrehabinsurancereimbursement.com.