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The Fine Print

Nephew Physical Therapy Policies

For a complete list of our patient policies, please see below – or use our quick links to navigate to a specific area of concern. You can also print and review our Billing Policy here.

Attendance Policy | Payment Policies | Billing Policies & Procedures | HIPAA

Attendance Policy

  1. Patients are asked to arrive on time for every appointment.
  2. Patients that arrive more than 15 minutes late for an appointment may be asked to reschedule.
  3. 24-hour notice is required for all cancellations.
  4. An $80.00 fee will be charged for missing the initial evaluation appointment without 24-hour notice. A $40.00 fee will be charged for each subsequent appointment missed without 24-hour notice.
  5. More than three cancellations may result in discharge from physical therapy.

Payment Policy
I authorize Nephew Services Inc. to bill my insurance company for payment of services. I understand that I am ultimately responsible for payment in full at this office. If I have no insurance coverage, I understand that the balance is due and payable in full at the time of treatment unless extended payment arrangements have been made between Nephew Services and me. I also understand that if I suspend or terminate my care as determined by my treating doctor and/or physical therapist, any fees for professional services will be immediately due and payable, unless both parties have agreed upon other arrangements. All payments are due within 15 days of invoice.  All balances not paid in full will incur a $10 late fee for each month that there is an outstanding balance. Patient is responsible for any & all legal fees associated with the collection of payment.

Billing Policies and Procedures

In an effort to make your Physical Therapy experience as smooth as possible, we have included information regarding the billing of insurance and payment for Physical Therapy below.

1. Billing Insurance Company: We will submit claims to your insurance company. To be able to do so we need up-to-date information from you, our patient. Information that insurance carriers require includes 1) Patient’s Name, 2) Patient’s Date of Birth, 3) Patient’s Social Security Number, 4) Insurance Card Holder’s Name and Date of Birth, 5) a Copy of Your Current Insurance Card(s), 6) Referring Physician’s Name.

2. Verification of Insurance Coverage: As a courtesy to our clients, we will verify your insurance coverage. We will give you an estimate based on whether your insurance company requires you to pay a) a deductible, b) a co-payment and/or c) a percentage of payment.

a) Deductible: The deductible information is based on the current information available with your insurance carrier. You will need to pay the remaining amount of your deductible to our office.

b) Co-payments are a flat rate that your insurance company requires you to pay at each and every Physical Therapy visit.

c) Percentage: Many insurance companies require that you pay for a percentage of the cost for Physical Therapy. We will provide you with what we estimate that amount to be based on our average payment per visit. This may vary based on your insurance company’s reimbursement rate and what treatment is rendered at each visit.

We recommend that you contact your insurance company directly regarding your cost for Physical Therapy.

3. Billing Charges/Codes: We will submit charges or codes to your insurance company after each visit. Physical Therapy is billed based on the service provided. The most common services we provide are…

a) Initial Evaluation (97001): Each individual must be evaluated to develop a treatment    plan. This is completed at the very first appointment for every individual.
b) Manual Therapy (97140): This is the hands-on portion of treatment. This includes, but is not limited to, soft tissue mobilization, joint mobilizations, myofascial release, etc. One unit equals 8-23 minutes of treatment as outlined by the government.
c) Therapeutic Exercise (97110): This includes strengthening, stretching, range of motion, etc. One unit equals 8-23 minutes of treatment as outlined by the government.
d) Ultrasound (97035): One code equals one session of ultrasound administered.
e) Electrical Stimulation (97014): One unit equals one session of electrical stimulation administered.
 

4. Explanation of Benefits (EOB’s): Most insurance companies provide their customers with an explanation of benefits outlining the charge submitted by the healthcare provider (NPT). Please refer to the list of codes above to better understand your EOB. The insurance company has an amount that they have determined to pay for that code. The insurance company may then further break down that charge into what you owe out of pocket, otherwise known as your co-payment. You may receive your EOB before we receive a payment from the insurance company.

5. Insurance Company Payments: Your insurance company will send us an EOB and a check if payment is due by them. This paperwork is first processed by our on-site office and is then forwarded on to our Billing Department. We use an off-site Billing Service. EOB’s are usually processed on-site within a week of being received. Keep in mind that most insurance companies take a MINIMUM of 1-month to make a payment to our office. We recommend patients make payments at each appointment to keep up with the requirements of insurance coverage.

6. Your Invoices: Once the insurance company’s payment and EOB are sent to the Billing Department, the information is entered into the billing software. Statements to patients are generated and postmarked by the 15th of each month. Services that have not been paid for are due by the 10th of the following month. We accept cash, check, and credit cards (VISA, Mastercard, and Discover).

7. Late Fees: Payments not received by the 10th of the month, as outlined on each statement, will incur a $10 late fee for each month that the balance is not paid in full.

8. Collections: Patients will be turned over to collections if no payment is received within three months after the completion of Physical Therapy.

9. Payment Plans: For individuals who are unable to pay a balance in full, payment plans are available. Patients will need to contact our office (616-796-9391) to make arrangements.

HIPAA
1. Uses and Disclosures of Protected Health Information (PHI)

  1. Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. This may include physicians, nurses, technicians, and other physical therapists.
  2. Payment: Your PHI will be used, as needed, to obtain payment for your health care services from your insurance company.
  3. Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of Nephew Physical Therapy. This includes quality assessment activities, employee review activities, the training of professional students, licensing, and conducting or arranging for other business activities.
  4. Other Special Uses: We may use your PHI to remind you of your appointments, to send you thank you notes, birthday cards or surveys, or to follow up on your previous care.

2. Your Rights

  1. You have the right to inspect and copy your PHI.
  2. You have the right to request a restriction of your PHI.
  3. You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
  4. You have the right to obtain a paper copy of this notice from us.
  5. You have the right to have your provider amend your PHI.
  6. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.

3. Complaints
You may complain to us or to the Secretary of Health and Human Services If you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our office of your complaint. We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to PHI. If you have any objections to this form, please ask to speak with our office in person or by phone at our main number.