Billing Do's and Don'ts: How MedExPROs Can Protect Their Practice

In the 27th tip from the MET 101 eBook series, Dr. Mike Jones addresses a critical issue for medical exercise professionals: the legality of billing for Medical Exercise (ME) services provided in a client's home when working under a physician not on the premises at the time services are rendered. Medical Exercise Specialists ARE NOT licensed to provide ANY form of physical therapy services.

Key Points:

1. Direct Supervision Requirement:
• Dr. Mike stresses that non-licensed professionals cannot provide ME services billed by a physician as therapy services, without providing direct supervision. The law requires the supervising licensed medical professional to be physically present and capable of overseeing the services provided directly. Also, the Medical Exercise Specialist may not provide services listed under the “Physical Therapy Act” for the state or province.
2. Insurance Fraud Risks:
• Billing exercise services provided in a client’s home as physical therapy treatment is inappropriate without a licensed physical therapist or assistant,. This constitutes insurance fraud. Not clearly indicating the exercise services are provided by a Medical Exercise Specialist and not a physical therapist is misleading. The key here is billing these services to an insurance carrier as "physical therapy treatment". 
3. Legal Consequences:
• Engaging in such billing practices can lead to severe legal consequences, including investigations by insurance companies and potential fraud charges. Dr. Mike warns that once an insurance audit occurs, the lack of proper licensing can lead to demands for repayment and possible legal action.
4. Best Practices:
• Medical exercise professionals should avoid working under arrangements where physicians bill for their services as “physical therapy”. Instead, any medical exercise services should be billed transparently and legally, ensuring compliance with state and federal regulations. Clearly indicate to the client and carrier your credentials if insurance reimbursement is sought. 
5. Seeking Guidance:
• Medical exercise professionals in such situations should seek immediate guidance to extricate themselves from potentially illegal arrangements. He offers his support and emphasizes the importance of understanding and adhering to legal requirements to avoid future complications.

Conclusion: This tip serves as a crucial reminder for medical exercise professionals to be vigilant about the legalities of their billing practices, especially when working under physicians. Ensuring compliance with supervision and licensing laws is essential to avoid the severe repercussions of insurance fraud. Get Your Free Copy: To explore more tips and insights, download your free copy of the MET 101 eBook at www.met101ebook.com