Can my Cash-Based Therapy Office Treat Medicare Patients?
You may be thinking that as a cash-based business you’re unable to treat Medicare patients but this is incorrect. While there are compliance issues that need to be considered while treating Medicare patients as a cash-based facility you're able to treat them, and they can have a place in your growing business.
If your cash-based business is still building clientele then working with Medicare patients may allow you to fill sessions that otherwise would remain vacant, thus allowing you to increase the cash flow of your growing business. As your business grows you can reduce the Medicare Clientele you treat in favor of clients paying your full session fees or limit your Medicare Clients specific times that remain difficult to book.
How does Medicare work with a cash based office?
A Medicare application will need to be completed to become approved to treat Medicare patients. Completing this application doesn't require you to become a preferred provider with Medicare it just allows you to treat Medicare patients. Without this approval from Medicare, it's against the law to treat Medicare patients even if they sign a release.
Once your application is accepted with Medicare you can start treating Medicare patients which can take 6-10 weeks. When you start treating Medicare patients you still collect your fees in full at the time of the service but the collected fees are dictated by the Medicare fee schedule. As a cash-based practice, you're not accepting an assignment with Medicare, this distinction allows you to increase the fees charged to the limiting charge. Medicare posts their fee schedule online so you can view this ahead of time.
Medicare does require that the provider submit the CMS 1500 for the patient this can be done by mail (depending on practice size) or electronic submission but you would not accept assignment since you collected the fees ahead of time. Not accepting assignment lets Medicare know that you have already collected the fees and to reimburse the patient.
Medicare would then process the claim and send reimbursement to the member.
Medicare compliance may scare you but it doesn't need to, Medicare offers a host of information on their website and with the time you can navigate this process.
As a medical biller, I'm aware of the compliance requirements of Medicare and can help you from completing the application, understanding the limiting charge and the fee schedule, submitting the claims electronically, and keeping up to date on changes to include the Therapy Cap, required modifiers and Advance Beneficiary Notice of Non-coverage. All of these things need to be taken into consideration when treating a Medicare patient.
I'm able to offer low flat monthly rate packages to help keep you compliant with Medicare while keeping your overhead down. Please reach out to discuss your needs and how I can help your growing business.