WHAT IS CASH-BASED PHYSICAL THERAPY?

In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. The patient pays in advance or at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. Even though this model is called cash-based you are not limited to cash payments, You may pay for services with cash, credit, debit, check, Flexible Spending Accounts (FSA), Health Savings Accounts (HSA) and Health Reimbursement Accounts (HRA).

Typically, coding for physical therapy services provided (CPT codes) is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any physical therapy practice and comply with all legal requirements.

INNER STRENGTH PHYSICAL THERAPY IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?

This simply means that the therapist has not entered into a contract with any individual insurance companies to receive reimbursement based on their contracted rates. There are many insurance companies, each with their own contracted rates and regulations, and Inner Strength chooses focus on what is best for the patient and not be limited by what insurance thinks is best. It is important to note that in network provider status is not based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.

CAN I BE REIMBURSED BY MY  INSURANCE FOR CASH-BASED PHYSICAL THERAPY SERVICES?

Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide the patient reimbursement for services received "out of network". Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to have access to specialized care. So the patient pays upfront for the care and the insurance reimburses their allowed amount based on that patients contract. The patient advocate on staff will assist patients who wish to be reimbursed by their insurance. The paperwork does not have to fall on the patient, we are here to help.

HOW IS MY PRICE DIFFERENT FROM INSURANCE BASED CLINICS?

In many cases, the out of pocket expenses for a course of physical therapy will actually be less for services provided at Inner Strength. In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical in network outpatient practice. Inner Strength can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service. This allows us s to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.

WHAT STEPS ARE INVOLVED IN SUBMITTING A CLAIM TO MY INSURANCE COMPANY?

Inner Strength has a patient advocate on staff to assist patients in the reimbursement process from start to finish. The process is actually quite simple: Inner Strength will provide you with an invoice at the time of service, you may choose to submit that invoice, along with your receipt of payment for said service to your insurance company for reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.

MY INSURANCE CARRIER IS MEDICARE - ARE THERE ANY SPECIAL RULES THAT APPLY TO PHYSICAL THERAPY SERVICES?

Outpatient physical therapy services are generally covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. However at this time Inner Strength is not a contracted provider with Medicare and therefore cannot accept cash payments from Medicare eligible patients with the exception of a one time Wellness Visit which is not reimbursable by Medicare.