Is in-home outpatient therapy paid for by Medicare?
Yes, physical, occupational, and speech therapy services provided by Goodcare AtHome Rehab are paid for by Medicare Part B, and most commercial insurances. It is NOT covered under Medicare Part A, as that is responsible for paying for home health therapy that requires the patient to be homebound. There may be a unique situation where an insurance company does not pay for a particular therapy code or procedure, but that is rare and at the discretion of each insurance plan.
Do I need a physician order for therapy?
Yes, we will need an order signed by your physician or nurse practitioner in order to begin therapy services.
Is there a limit on how much therapy I can have?
Medicare Part B has a yearly cap on the amount of outpatient therapy. Currently the cap is $1980 for physical and speech therapy combined, and $1980 for occupational therapy. The good news is there is currently an exception process to allow you to go over the cap as long as the therapy services continue to be reasonable and medically necessary. Goodcare AtHome Rehab will monitor requirements to apply the cap should it be necessary in your treatment.
If your primary payer is a commercial insurance company, or you have a Medicare replacement plan, Goodcare AtHome Rehab billing staff will obtain authorization for the number of visits allowed by the insurer.
What insurances to you accept?
We accept a wide variety of insurances. We choose to be in network with some insurances and out of network for others. Our in network participation is primarily for Medicare, Medicaid, or for those insurances who have a Medicare replacement plan. Supplemental insurances do not require us to be in network to reimburse their portion of the claim. Please contact Goodcare AtHome Rehab at 605-988-4528 if you have questions about our ability to accept your insurance plan.
Do you verify insurance coverage?
Goodcare AtHome Rehab will make their best effort to verify primary insurance benefits based on the information received from the patient prior to start of therapy. If we are out of network with an insurance company, we will notify the patient or the responsible party to ensure that they are aware of their plan's out of network coverage and gain approval for initiation of therapy. Due to the individual nature of insurance coverage and benefits, it is ultimately the responsibility of the patient and/or responsible party to be aware of any coverage or benefit limitations.
Do you offer private pay therapy?
If the therapist determines that your therapy is no longer medically necessary, but you desire to continue with our services, we will present you with an Advanced Beneficiary Notice (ABN) and inform you of all your options in billing the continuation of your therapy services. At that time, the private pay rate will be discussed with you and your signature on the ABN will be recorded.