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Best Way To Attract More New Cash Pay Physical Therapy Patients

by | May 28, 2022 | Medicare

Attract More New Cash Pay Physical Therapy Patients in 2022

Okay, before you freak your freak this isn’t clickbait. If you want to Attract More New Cash Pay Physical Therapy Patients in 2022 the easiest way to do it is…

Become a contracted Medicare provider!

Cash Pay Physical Therapy and Medicare

Let’s be clear. If you want to treat an adult, geriatric population you are swimming upstream by not simply becoming a contracted Medicare provider.

CMS Chapter 15 Section 40 clearly states that physical therapists, occupational therapists, and speech language pathologists are not eligible to opt out of Medicare. These providers are required to abide by the “mandatory claim submission law” which basically states that if you are a licensed healthcare provider providing what would normally be considered a covered service to a Medicare beneficiary you are required, by law, to submit a claim on behalf of that beneficiary.

If you have no contract in place with Medicare you have no way to submit that claim.

Medicare Opt Out Providers Physical Therapists
Physical Therapy Mandatory Claim Submission Law

When Can A Physical Therapist Charge A Medicare Beneficiary Cash?

There are a handful of cases in which a non-Medicare contracted physical therapist may charge a Medicare beneficiary cash for services.

1. When your patient is receiving Medicare covered services from another contracted therapist.

For example, if a Medicare beneficiary comes to you for a physical therapy evaluation because you provide highly specialized service, but you are not a contracted Medicare provider, you may have that patient recieve a Medicare covered initial evaluation and follow up care from a contracted provider while you provide additional, supplemental, non-covered services.

2. When you determine that your patient doesn’t require Medicare covered services.

For example, if a Medicare beneficiary is scheduled to play in a pro am golf tournement tomorrow and he wakes up with a kink in his neck. He could go get a massage, but he wants a TPI certified physical therapist with a sports performance background to work the kink out. This is not a covered service.

Of when a patient is seeking wellness or performance services for general health, this is not a covered service and available to you for self pay.

3. When your patient has been discharged from physical therapy at a contracted provider’s clinic and wants to hire you for continuity services.

Often, high performers understand the benefits of working with great professionals. If you have a client who is seeking you out for your advanced knowledge and training and the client is a Medicare beneficiary who has already received conventional care and been discharged, then you may be eligible to accept this client as a cash pay client. 

How Does Becoming A Contracted Medicare Provider Grow A Cash Pay Clinic?

The biggest barrier to growing a cash pay clientelle is trust.

Prosective new patients don’t know you, they don’t like you, and the certainly don’t trust you. If you tell them you are a physical therapist and the guy down the streat is also a physical therapist, but you charge $250 a session and the guy down the street is “Free with Medicare” then most clients will take a change on the free guy.

But once you become a contracted Medicare provider you eliminate the competitive advantage for the other providers.

Objections to Becoming a Contracted Medicare Provider

1. Medicare pays to low a rate for me to do what I do.

True, Medicare pays less than your cash rate, but you are not required to accept every Medicare referral. For example, if you only treat outpatient orthopedic conditions and you receive a neurologic related referral you are encouraged to refer that patient to a different therapist.

You may choose to only accept Medicare beneficiaries who also accept your self pay recommendation. For example, if you specialize in golf performance you might only accept Medicare referrals who will purchase your non-Medicare covered golf performance program. 

In this cases your Medicare beneficiary will pay out of pocket for the golf performance component of your treatment plan while allowing Medicare to pay for the evaluation, the therapeutic exercise, and perhaps the therapeutic activity covered services.

2. Medicare has too many regulations and guidelines to follow.

I can tell you that I have posted multiple surveys in my Facebook group Medicare Billing for (Mostly) Cash Based PT, OT, SLP and nearly unanimously the sentiment around Medicare is positive once the therapists understand the Medicare guidelines.

Is Medicare Worth Joining As A Physical Therapist
Is it worth contracting with Medicare as a physical therapist
Anthony Maritato, PT

Anthony Maritato, PT

Private Practice Owner / Physical Therapist

After starting a private practice physical therapy clinic in 2022 with his wife Kathy Maritato, PT, Tony and Kathy grew their practice to five locations across two states.

Now, Tony and Kathy enjoy spending time treating patients in the morning, coaching therapists in the evening, and being home to play with their dog Tucker and 4 boys.