Is it permissible for a physical therapist to collect out-of-pocket payment from a Medicare beneficiary for a service not covered by Medicare?

• A. Yes
• B. No
• C. Only if the patient signs a waiver
• D. Only if the service is allowed by the facility

Answer: (B)

Medicare protects beneficiaries from being charged for services that aren’t covered. A physical therapist cannot solicit or collect out-of-pocket payments from a Medicare beneficiary for a service that Medicare does not cover as part of the Medicare billing process. This would amount to balance billing, which Medicare rules prohibit. Even if the patient signs a waiver or if the service is allowed by the facility, those factors don’t override Medicare’s billing rules. The patient can be informed about non-covered services, and such services may be offered as private pay outside Medicare billing, but within the Medicare context you should not collect the out-of-pocket amount for a service Medicare doesn’t cover.