I have read so much misinformation on social media platforms regarding the billing of patients who have Medicare Advantage (MA). However, the provider of the therapy services is not contracted with the patients MA plan. Because of this, many therapists and practices may be in violation of federal law and protections for MA beneficiaries regarding out-of-network (OON) billing. In this article, I am going to answer the following questions.

With stagnant or decreasing reimbursement and rising expenses, more practices are considering going out-of-network (OON) with some insurers. However, what information must owners consider when making this decision? In this article (Part 1 of 3), I will answer the following questions:

This webinar will provide participants with information on how to bill and get reimbursed when the provider is out-of-network with the insurance carrier or insurance plan.

As more and more practices choose not to enroll with commercial insurance carriers, including Medicare Advantage programs, a common question I am asked is must I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries. In this article, I will provide the answers (with resources) to some of the more common questions I receive. QuestionMust I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries? Answer QuestionWhat does TRICARE mean when they state “any TRICARE-authorized provider who hasn’t joined the network is a non-network provider? Answer QuestionCan a physical therapist

Lately, I have been receiving questions from providers who are not contracted with Medicare Advantage plans and who want to know if they can evaluate and treat those patients and charge them cash. In this article, I will answer the following questions: I’m enrolled in the Medicare program as a participating provider and not enrolled with the Medicare Advantage (MA) plan. The MA plan does have out-of-network (OON) benefits. Must I submit a claim to the MA carrier and are there limitations in how much I can charge the patient? I’m enrolled in the Medicare program as a non-participating provider