Understanding Medicare

Understanding Medicare
The staff at FIT Rehab will do everything they can to help you understand your Medicare coverage, and to use this coverage to offer you the best care possible.

In order for Medicare to cover physical therapy do I need a prescription?
FIT Rehab is happy to work with you on requesting a script prior to your initial evaluation.  We work with you to make sure your physician is aware and approves your need for physical therapy.  You may technically attend your initial evaluation for physical therapy without a prescription from your doctor, the physical therapist will send a report to your doctor after your initial evaluation, and will need it returned and signed in order for Medicare to approve payment to our facility.

How much will Medicare cover for each visit? Will I have to pay anything?
After your annual deductible has been satisfied (2013 deductible was $147.00), Medicare will cover 80% of the Medicare Fee Schedule.  However, if you have secondary insurance, they will often cover most if not all of the balance not covered by Medicare.  You should always be aware of your secondary insurance coverage and whether or not it covers the deductible, as well as how much of the 20% remaining charges it covers.

Is there a limit to the length of time I can attend physical therapy throughout the year?
There is a limit on the amount Medicare will cover for each calendar year, which currently stands at $1,900 for 2013.  This amount can cover anywhere from 3 times a week for 6 weeks of treatment, the therapist can also request an exception to this limit and continue treatment when deemed “medically necessary”.

How will I know if I have reached this limit?
You should always alert FIT Rehab if you have already had physical therapy at some point during the calendar year.  The staff at FIT  Rehab will verify your coverage with Medicare, and will document the amount of physical therapy you have already used.  We will carefully track your usage from that point on and will alert you when approaching the limit.

I am currently being treated in home care, but I know I will be ready for out-patient physical therapy in the next week or two. Can I schedule my appointment now?
You may schedule your appointment with FIT Rehab as soon as you are certain you are about to be discharge by your home-care physical therapist. You must be signed out of home-care, and Medicare must be alerted before they will begin to cover out-patient physical therapy.