5 Things Medicare Won't Pay For—But You Should Still Provide in Your PT Clinic

Oh Medicare, you sure don’t like to make things easy for physical therapists, do you? Thanks to everything from payment cuts to slow-moving legislation, PTs have started venturing beyond the traditional reimbursement models and adding cash-based services to their repertoire. At the same time, our aging population is bearing more and more of the healthcare spending burden, which has caused many to seek out alternative services that promote long-term health and wellness—even if it means paying out of pocket. So, what are these services? And is it really worth it for PTs who treat Medicare patients to provide them? Read on to find out:

Why?

Before we jump into the specifics, let’s talk about the “why.” After all, getting Medicare patients to pay out of pocket for any service could seem like a tough sell, so is it really worth the investment? Yes, and here’s why:

• It creates a unique marketing opportunity. Every item on the list below has a whole market of patients who are willing to pay cash for that exact service—but not every practice offers these services. By setting yourself apart from the competition and advertising your unique offerings, potential patients seeking them out will choose you over your competition.
• For some of the things listed (e.g., telehealth), there are legislative efforts currently underway that will eventually make them reimbursable under Medicare. So, it’s good to already have the infrastructure necessary to provide them in place. That way, when Medicare does begin reimbursing PTs for them, Medicare patients can begin taking advantage of your services right away.
• As any PT who works with Medicare patients should know, you cannot accept cash payment for services typically covered by Medicare. However, because Medicare does not reimburse for these services, your patients can pay out-of-pocket for them—thus allowing you to circumvent the prolonged reimbursement process and create instant cashflow.

{{inline-form}}

1. Health and Wellness Programs

As explained in this article from E-Health Medicare, neither Medicare Part A nor Part B covers the cost of health programs such as group fitness classes. However, Part B may cover certain health services such as nutrition counseling—provided that the patient receives said services from a registered dietitian or other qualified healthcare professional. Furthermore, there are a couple of Medicare-funded fitness programs in which your practice may be able to participate (e.g., SilverSneakers and Silver and Fit). Also, some Medicare Advantage plans may cover health programs, so each patient should verify this with his or her payer.

2. Retail Items

Some practices offer therapeutic or consumable products—everything from CBD oil to protein powder. If a practice doesn’t quite have the space or staff to provide extra onsite services, growing the retail side of the business can be an excellent way to diversify revenue streams. These items are also fairly easy to sell, because PTs can use the same products—from fitness bands to kinesiology tape—during treatment sessions and show patients how they can incorporate them into their home regimens. Then, before they leave the clinic, patients can purchase those very same products right there at the front desk and them home right away. 

3. Telehealth

You’re probably familiar with the concept of telehealth—a.k.a. “telerehab”—but here’s a quick rundown: according to HealthIT.gov, telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.” As for its relevance to PTs, telehealth can enable providers to see more patients in a day by making quality physical therapy services more accessible to patients who have limited mobility or live in rural areas. 

While Medicare doesn’t currently recognize PTs as eligible providers when it comes to telehealth, according to the APTA, “Legislation that specifically addresses telehealth in physical therapist practice is sparse but gaining momentum as telehealth legislation has been developed in other areas of medicine such as radiology and psychology.” Some non-Medicare payers have even started recognizing physical therapists as approved providers for telehealth exams.

4. Dry Needling

According to the Mayo Clinic, “Dry needling is a treatment performed by skilled, trained physical therapists, certified in the procedure. A thin monofilament needle penetrates the skin and treats underlying muscular trigger points for the management of neuromusculoskeletal pain and movement impairments.” The service has a wide variety of uses when it comes to treating musculoskeletal issues. Patients use it to alleviate everything from shoulder and neck pain to back and foot pain. While more and more insurance payers recognize dry needling as a safe and effective intervention, some insurances may not reimburse for it.

For the time being, dry needling is overwhelmingly regarded as a cash-pay service. However, as dry needling legislation and insurance coverage evolves, it could likely become a physical therapy mainstay. Either way, this service is popular among patients. Many swear by it, and demand for it is clearly on the rise. 

5. Massage Therapy

According to research from McMaster University in Canada, muscle tissue that was massaged prior to exercise not only repaired faster but also produced less inflammation than tissue that was not massaged—meaning patients undergoing intense PT exercise can benefit from massage therapy services. So, it’s no wonder more and more physical therapy practices are incorporating therapeutic massage into their list of ancillary services.

But adding massage services isn’t just a smart investment in your patients’ health—it’s also a big-time money maker. Because consumers are already accustomed to paying out of pocket for massage services, they’ll be less concerned with the fact that Medicare doesn’t cover it and more willing to pay cash for massage services in a physical therapy practice. 

Don’t let a lack of reimbursement potential fool you into thinking health and wellness services aren’t worth your time. With the right strategy, expanding your service offerings into the realm of cash pay could be just the right move for your practice and your patients—Medicare reimbursement not required.