Must I Enroll in Medicare to Treat Medicare Patients

I am often asked must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries for outpatient therapy services that are covered by the Medicare program? This then leads to a second question I am often asked. If PTs, OT’s and SLPs must enroll in the Medicare program, what is this non-participating provider status? Doesn’t this mean I don’t participate with Medicare, hence, I can charge the Medicare beneficiary cash for outpatient therapy services? How about services that are statutorily non-covered by the Medicare program; can I charge the Medicare beneficiary cash for those services?

In this article, I will answer the following questions:

• Must PTs, OTs and SLPs enroll in Medicare if they want to treat Medicare patients for covered services?
• What is the difference between enrolling as a participating provider and a non-participating provider with the Medicare program?
• If I enroll as a non-participating provider, does this allow me to bill Medicare beneficiaries cash for outpatient therapy services covered by the Medicare program?
• When can I bill Medicare beneficiaries cash for services I provide without submitting a claim to the Medicare program?

Question #1: Must PTs, OTs and SLPs enroll in Medicare if they want to treat Medicare patients for covered outpatient therapy services?