Wellness and Cash-Based Services for Medicare

Today’s blog post comes from Ann Wendel, PT. Ann is the owner of PranaPT, a member of WebPT, and an active social media participant (@PranaPT). Thanks, Ann!

Due to all of the recent changes in Medicare documentation and billing requirements, I have had an increase in the number of questions from other physical therapists regarding cash-based services for Medicare patients.

In past articles, I have discussed the inability of physical therapists to “opt out” of Medicare. Today, though, I want to discuss the provision of wellness services on a cash-pay basis for Medicare-age clients.

I have not been able to find a detailed definition of what constitutes “wellness services” for Medicare patients; however, the general consensus among those of us who are cash-based providers is that we provide wellness services when we are not treating a specific injury, pain, or dysfunction and we are maintaining a level of fitness/strength and/or we are preventing falls or decline of health. Jarod Carter does a great job of explaining this here.

Wellness services are most appropriate for those patients who will benefit from supervised exercise, movement, and balance training for overall health. These may include patients who are ready for discharge from formal physical therapy due to meeting goals or patients who would like the guidance of a physical therapist for a generalized exercise program.

Based on the interests and certifications of the therapists in your clinic (or contractors that you bring in), examples of cash-based services can include:

• Pilates Mat and Reformer sessions
• Weight training with either free weights or machines
• Kettlebell training
• High-level balance training activities
• Falls prevention workshops
• Tai Chi classes
• Yoga classes
• Aquatic therapy

You can price services at whatever the market supports in your area. I suggest looking at the average price of a session with a sought after local personal trainer and then pricing up a bit from there. Patients can pay per session or buy a package of five or ten visits.

Before you add cash-based wellness services, you will want to review your liability policy to be sure that services other than “physical therapy” are covered. You may also want to ask Medicare patients to sign an ABN if your compliance expert recommends that you do so.

As a large part of the US population reaches Medicare age, physical therapists should be ready to step in to meet the wellness needs of those in our local communities. We have an excellent understanding of general medical conditions, medications, and surgical procedures which helps us to develop appropriate exercise programs for seniors. With a bit of creativity, we can continue to help this patient population meet their fitness and health goals even after discharge from physical therapy.

Have you added any cash-based services for Medicare-age clients in your clinic? I would love to hear what others are doing!