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?
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Can you explain how to navigate the situation when a new grad starts and they do not have their respective numbers for BC and Medicare. Can we sign for them to do BC and Medicare pts before they have their ID numbers? We are getting their NPI but from there, can we bill if another PT cosigns?
You would need to check with your BCBS insurance carrier to see what they allow.
What about PT/OT/ST who work for an acute care hospital and are seeing pt’s for PT/OT/ST in the Emergency Room or in the hosptial who are classified as Observation Status?
Do those PT/OT/ST staff have to have to be enrolled in the Medicare program?
In a non-private practice setting, you do not bill under the NPI of the individual therapist. You bill under the facility NPI.