Clarification of Brenda Shaeffer, PT, DPT’s Medicare Status
Brenda Shaeffer, PT, DPT is a non-Medicare Provider. We do not have a provider number with Medicare. Because we do not have this number, Medicare will not cover services with us that are deemed “medically necessary”. Unfortunately this means that even if the patient is comfortable paying out of pocket, we legally cannot see them. Medicare’s concern is that Medicare patients should not be taken advantage of and that even if an “Advance Beneficiary Notice” of non-Medicare coverage is signed, it does not assure that the Medicare patient understands that they are not eligible for reimbursement.
We are able to evaluate Medicare patients whose goals are NOT medically necessary, or as Medicare puts it, those who are looking to be seen for “wellness and maintenance” reasons. (For example, athletes with hip pain hindering them from competing.) For these services, you will receive a statement without any medical coding. Without medical coding, statements cannot be submitted to insurance for reimbursement.
Question:Why doesn’t Brenda Shaeffer, PT, DPT apply for a Medicare Provider Number?
Answer: Brenda Shaeffer,PT, DPT does not want insurance companies to dictate the quality of care that we provide to our patient. We are able to spend more time with you, caring for your condition than we would if we had to keep up with the administrative responsibilities and updates/changes to the Medicare system.
Question:What is the difference between “medically necessary” and “wellness and maintenance?
Answer: Those seeking Physical Therapy for post-surgical rehab, to treat injuries from a fall, any chronic injuries would all be examples of “medically necessary” patients. As a non-Medicare Provider, Brenda Shaeffer, PT, DPT cannot treat these cases.
Wellness and Maintenance would be classified as any patient with a fitness related goal, such as: reducing pain during exercise, an evaluation to work with a personal trainer, seeking to attain proper alignment before a vacation, etc. All “wellness and maintenance” patients will be responsible for the cost of the appointment, will be required to sign an Advance Beneficiary Notice, and will receive a statement without medical coding. These visits cannot be submitted to Medicare for reimbursement under any circumstance.
Physical Therapy/Work and Sport Rehab/ Performance Training, Education and Consulting
Brenda E. Shaeffer LLC