1. High-Value Self-Pay Services

Learn how to identify and offer premium self-pay services that complement Medicare-covered care. We’ll show you how to structure these services to maximize patient satisfaction and revenue.

2. Remote Therapeutic Monitoring (RTM)

Discover how to integrate RTM into your Medicare-covered plans of care—and how to transition these services to self-pay once the plan of care is no longer considered reasonable and necessary.

3. Social Media Marketing That Works

Get up-to-date strategies for marketing your practice on social media platforms. We’ll show you what’s working now and how to attract patients without spending hours online.

These new features are designed to help you grow your practice, deliver exceptional care, and create the work-life balance you deserve.

Module 1: Setting the Stage for Success

Overview

In Module 1, we lay the foundation for your journey into private practice by discussing the current professional environment and the opportunities that hybrid business models present for PTs, OTs, and SLPs.

Key Topics Covered:

• Understanding Hybrid Business Models:

  • Learn how clinics are leveraging Medicare as a lead generation tool to attract beneficiaries and offer premium self-pay services.
  • Explore how this approach delivers higher-quality care and creates sustainable income streams.

• The State of the Profession:

  • Analyze why conventional business models are struggling and how hybrid models are paving the way for the future of therapy services.
  • Discuss the growing demand for therapists to combine clinical excellence with entrepreneurial skills.

• Current Affairs and Future Trends:

  • Telehealth and Medicare: Understand the future of telehealth coverage and its impact on your practice.
  • Supervision Requirements: Get updated on the latest rules for supervising OTAs and PTAs.
  • Remote Therapeutic Monitoring (RTM): Learn how RTM is becoming an essential tool for therapists and how to integrate it into your practice.
  • Caregiver Training Reimbursement: Discover how you can offer caregiver training and get reimbursed under Medicare.

Module 2: Admitting a Medicare Beneficiary

Overview

In Module 2, we dive into the practical steps of admitting a new Medicare beneficiary into your practice. This module is your comprehensive guide to mastering the administrative and clinical processes necessary to start delivering therapy services confidently and efficiently.

Key Topics Covered:

• Verifying Medicare Coverage:

  • Step-by-step instructions for confirming a patient’s Medicare eligibility and utilization toward the financial threshold.

• Onboarding Process:

  • Detailed guidance on creating a seamless onboarding experience for new Medicare patients, including:
    • Email sequencing for patient communication.
    • Text messaging strategies to enhance patient engagement.
    • Gathering and managing medical release forms and HIPAA privacy notices.

• Documentation Essentials:

  • Learn the required documentation to admit and treat a Medicare beneficiary, ensuring compliance with Medicare regulations.

• Integrating Service Models:

  • Explore the flexibility of combining different service delivery methods, including:
    • Telehealth Services: How to incorporate virtual visits into your workflow.
    • Mobile Therapy Services: Adapting to patients who prefer in-home care.
    • Brick-and-Mortar Practice Services: Best practices for in-clinic care.
    • Remote Therapeutic Monitoring (RTM): Integrating RTM to enhance patient outcomes and maximize revenue.

Module 3: Creating and Submitting Medicare Claims

Overview

In Module 3, we tackle the critical skill of creating and submitting Medicare claims for physical therapy, occupational therapy, or speech-language pathology services. This hands-on session ensures you fully understand the claims process, from selecting the right CPT codes to navigating fee schedules and modifiers, setting you up to minimize denials and maximize reimbursements.

Key Topics Covered:

• Mastering the CMS 1500 Claim Form:

  • Step-by-step guidance on completing each field of the claim form.
  • Common errors that lead to claim denials or rejections—and how to avoid them.

• CPT Code Utilization and Modifiers:

  • Understanding how to select and apply appropriate CPT codes for therapy services.
  • Exploring modifiers and when they are required for accurate claim submission.

• Fee Schedules and Pricing Strategies:

  • Why practices are expected to maintain a fee schedule 2-3 times higher than Medicare's allowed amount.
  • Leveraging the Prompt Pay Discount to reduce bill rates for self-pay services while maintaining compliance.

• Submitting Claims to Various Payers:

  • How to create claims for primary and secondary insurance companies.
  • Special considerations for Medicare, Medicare Advantage, and non-Medicare payers.

• Real-Life Scenarios and FAQs:

  • Addressing common concerns, such as understanding coordination of benefits and handling rejected claims.

Module 4: Understanding Payments and Patient Responsibility

Overview

Module 4 focuses on interpreting payments and financial adjustments from Medicare, Medicare Advantage, and non-Medicare insurance companies. This session will empower you to understand payment terminology, read explanation of benefits (EOBs), and accurately calculate patient responsibility, ensuring clarity and compliance in financial transactions.

Key Topics Covered:

• Key Insurance Terminology:

  • Break down essential terms like:
    • Premiums
    • Deductibles
    • Copays
    • Coinsurance

• Reading Explanation of Benefits (EOBs):

  • Learn how to identify and interpret key details, including:
    • Billed Rates
    • Allowed Amounts
    • Adjustments
    • Payments

• Addressing Payment Reductions and Adjustments:

  • Understand common reductions, including:
    • MPPR (Multiple Payment Procedure Reduction): Why some line items are reimbursed at lower rates.
    • Sequestration and Contract Adjustments: How these impact payments and reimbursements.

• Estimating Patient Responsibility:

  • Learn what a provider is allowed to collect from patients based on their insurance.
  • Discover how to estimate patient out-of-pocket costs accurately and communicate this effectively.

• Real-World Scenarios:

  • Practical examples to illustrate different payment situations and how to handle them.

Module 5: Navigating Medicare Advantage and Non-Medicare Insurance Plans

Overview

Module 5 is dedicated to understanding Medicare Advantage and non-Medicare insurance plans, with a focus on therapists who wish to remain out-of-network. This module equips you with strategies to manage patient interactions, develop compliant policies, and provide clarity about coverage options—all while protecting your time and ensuring patients can make informed decisions.

Key Topics Covered:

• Medicare Advantage Plans:

  • Understanding the differences between Medicare and Medicare Advantage.
  • Strategies for remaining out-of-network while still serving patients with Medicare Advantage plans.

• Non-Medicare Insurance Plans:

  • Policies and procedures for billing non-Medicare insurance plans while staying out-of-network.

• Key Terminology and Policies:

  • Balance Billing: When and how it applies.
  • Good Faith Estimate: Developing compliant procedures to provide accurate cost estimates to patients.
  • Establishing policies that protect your time while meeting legal and ethical requirements.

• Insurance Benefits from a Consumer Perspective:

  • Learn to evaluate and explain health insurance benefits to patients.
  • Gain insight into purchasing health insurance and understanding key benefits to better educate patients on their options.

Module 6: Combining Covered and Non-Covered Therapy Services

Overview

Module 6 delves into strategies for integrating Medicare-covered and non-covered therapy services within your practice. You’ll gain a clear understanding of how to use the Advance Beneficiary Notice (ABN) to maintain compliance while offering non-covered services, creating a modern hybrid practice model that enhances patient care and revenue.

Key Topics Covered:

• Understanding the Advance Beneficiary Notice (ABN):

  • Mandatory ABN vs. Voluntary ABN: Learn the difference and when each is required.
  • Step-by-step guidance on completing and using the ABN to document patient consent for non-covered services.

• Covered vs. Non-Covered Therapy Services:

  • Understand Medicare’s guidelines for covered maintenance therapy and how to offer non-covered maintenance therapy as a self-pay option.
  • Examples of non-covered services, such as dry needling, and how they can be integrated into treatment sessions alongside Medicare-covered care.

• Hybrid Practice Models:

  • Traditional Approach: Completing a Medicare-covered plan of care, then discharging patients to initiate self-pay services.
  • Modern Approach: Introducing self-pay services concurrently with Medicare-covered care, allowing for seamless continuity and enhanced patient outcomes.

• Practical Applications:

  • How to explain and document the combination of covered and non-covered services to patients.
  • Strategies for ensuring compliance while maximizing the value of each patient interaction.

Module 7: Mastering Medicare Documentation

Overview

Module 7 focuses on Medicare's required documentation guidelines, equipping you with the knowledge and tools to ensure compliance and accuracy in your records. Using the CMS Chapter 15 Medicare Benefit Policy Manual (Sections 220 and 230) and articles from various Medicare Administrative Contractors (MACs), this module provides a comprehensive understanding of documentation best practices.

Key Topics Covered:

• CMS Documentation Guidelines:

  • Detailed review of Sections 220 and 230 of the Medicare Benefit Policy Manual.
  • Key documentation requirements for initial evaluations, progress notes, and discharge summaries.

• Insights from Medicare Administrative Contractors (MACs):

  • Review specific MAC articles to understand regional variations in Medicare requirements.
  • Practical tips for addressing MAC-specific documentation expectations.

• Examples of Effective Documentation:

  • Real-world examples of compliant documentation.
  • Common pitfalls and how to avoid them in your practice.

• Electronic Medical Records (EMRs) vs. Paper Documentation:

  • Explore the pros and cons of using EMRs versus traditional paper documentation.
  • Discuss popular EMR systems for PT, OT, and SLP providers and how to choose the best fit for your practice.

Module 8: Navigating Medicare Audits and Documentation Compliance

Overview

In Module 8, we build on the foundation of Medicare documentation by diving into the intricacies of Medicare audits, specifically the Targeted Probe and Educate (TPE) process. This module equips you with the tools and strategies to prepare for and manage audits effectively, while also addressing documentation requirements for non-Medicare insurance plans.

Key Topics Covered:

• Understanding TPE Audits:

  • Overview of the TPE process and what auditors look for.
  • Step-by-step review of the documentation requirements for TPE audits.
  • Real-world examples of documentation that successfully passed TPE audits.

• Non-Medicare Insurance Audits:

  • Insights into audit requests from non-Medicare insurance plans.
  • A review of non-Medicare documentation guidelines to ensure compliance across all payers.

• Audit Preparation Tools:

  • Internal Medicare audit checklist to verify documentation before submission to third-party payers.
  • Resources and tools to streamline audit responses and minimize stress.

• Reducing Audit Risk:

  • How to request and analyze a Comparative Billing Report (CBR) from Medicare to identify and address potential red flags.
  • Best practices for maintaining documentation that meets Medicare and non-Medicare guidelines to lower audit risk.

Module 9: Marketing Your Medicare Practice

Overview

Module 9 focuses on building and executing an effective marketing strategy for your Medicare practice. This session will cover everything from foundational concepts like creating a unique value proposition to specific, actionable tactics to attract and retain patients.

Key Topics Covered:

• Marketing Foundations:

  • Understand key marketing principles, including:
    • Push vs. Pull Marketing: What they are and when to use them.
    • Insights from renowned marketing authors like Seth Godin and Rory Sutherland.
  • Define your Unique Value Proposition (UVP): Stand out in the marketplace by clearly communicating what makes your practice unique.

• Social Media Marketing:

  • Explore what’s working now compared to previous trends.
  • Strategies for leveraging platforms to attract Medicare patients and build trust.

• Specific Marketing Strategies:

  • Live Seminars: Host in-person events to educate potential patients about your services.
  • Virtual Webinars: Reach a wider audience and position yourself as an expert.
  • Attending Patient Follow-Up Appointments: Build relationships by collaborating with referring providers.
  • Additional tactics tailored for local and virtual audiences.

• Real-World Applications:

  • Examples of successful Medicare practice marketing campaigns.
  • Practical tips to implement these strategies on a budget and with measurable outcomes.