Southwest Orthopaedic Physical Therapy Information Headquarters

3 Things to Know about Medicare and Physical Therapy

Posted by Dani Livsie on Aug 11, 2011 4:39:00 PM

Medicare Card ExampleMedicare is an insurance company that people get through the social security administration. Medicare has been a system that has been providing valuable health benefits at a low cost. This makes it easier for many people to receive health benefits especially as they retire and no longer are covered under their employers insurance. Medicare can be a confusing system to navigate and the rules and regulations may seem endless. Physical therapy is a specialty service and this makes the rules and regulations even more challenging to navigate. To make it easier to understand, here are a few important things to know about the rules that are placed with physical therapy.

1. The Physical Therapy Cap

The physical therapy cap is very confusing to both medicare beneficiares as well as providers. The laws for the cap changes quite frequently so it is best to ask Medicare for the current rules and regulations for the cap. The 2011 Medicare Cap is $1870. That means that for each Medicare beneficiary, a dollar amount of $1870 can be used for the entire year. The cap starts on January 1st and lasts until December 31st. Each year's cap is seperate from the other so every year the cap will start over again.

2. Co-Insurance and Deductible

Medicare covers all the medical providers cost at 80%. That means that the beneficiaries will have a co-isurance of 20% to pay to the providers unless they have a supplemental insurance that will cover it. In addition to the co-insurance, there is also a deductible that changes yearly for all beneficiares.

3. Modifiers

Modifiers are used in billing as a way for the provder to signal to the insurance company about a certain situation. For example, physical therapy services for Medicare and recognized throught the GP modifier. That modifier goes on every charge and it the way the cap is kept track of. Medicare beneficiares can see those modifiers on the explanation of benefits that come from the insurance company.

At Southwest Orthopaedic Physical Therapy in Albuquerque, New Mexico, we try to help our patients as much as possible when dealing with billing Medicare and explaining the different rules. Click here for a printable prescription to bring with you to your next doctor's office.

Topics: physical therapy, health insurance