FREQUENTLY ASKED QUESTIONS
***Isn't Medicare Paying for My Therapy Already?***
Medicare pays only for the portion of therapy that is treating a specific diagnosis that meets medical necessity and skilled care.
Titan Concierge does not provide physical therapy. It is access and services focused on you performing better and helping with your overall fitness and well-being.
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At Titan we treat the whole body system and provide you with exercises and interventions to help you get the best results possible.
According to the Social Security Act Section 1862(a)(1)(A) “No Medicare payment shall be made for expenses incurred for items or services which . . . are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” And in Medicare Claims Processing Manual Ch. 5 Note it states that because a service is considered an outpatient
rehabilitation service does not automatically imply payment for that service.
***What Is A Covered Service?***
To be considered reasonable and necessary, the services must meet Medicare guidelines. The guidelines for coverage of outpatient therapies have basic requirements in common.
Per Local Coverage Determination L34049, “A service is not considered a skilled therapy service merely because it is furnished by a therapist ... Skilled therapy services may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.
Services that do not require the professional skills of a therapist to perform or supervise are not medically necessary ... Services related to activities for the general good and welfare of patients, such as general exercises to promote overall fitness and flexibility, and activities to provide diversion or general motivation, do not constitute (covered) therapy services for Medicare purposes. Services related to recreational activities such as golf, tennis, running, etc., are also not covered as therapy services ... Therefore, if a patient’s therapy can proceed safely and effectively through a home exercise program, self management program, restorative nursing program or caregiver assisted program, payment cannot be made for therapy services.”
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=34049&ver=34&
***Am I Required to Pay an Additional Fee for Physical Therapy?***
There is no additional fee for physical therapy. All insurance covered services will be charged through your insurance plan. Titan Concierge is an independent program that is provided by the therapists at Titan Physical Therapy.
Here at Titan Physical Therapy we are trained to look at you as a whole person rather than pigeon-hole your one ailment. A key part of what we focus on is making you have greater capacity and tolerance to what life throws at you. We know if your body system is not healthy, it is going to limit your overall recovery and prevent you from reaching your goals.
Your fee for Titan Concierge provides you a number of benefits that are non-covered services and outside insurance coverage. These benefits include additional education, wellness visits to address overall health and fitness, and more frequent screening opportunities to live a better life. Unfortunately, access to these benefits is not normal practice for most clinics. Your Doctor of Physical Therapy here at Titan will provide you with the highest level of direction to address you as a whole and this is what therapeutic wellness covers.
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***What If I Want Care for My Problem After Medical Necessity?***
No problem, we will provide you with an Advanced Beneficiary Notice of Noncoverage (ABN).
This will allow you to select one of three options:
1) if you want us to submit a claim and see if Medicare will continue to cover the service;
2) continue treatment that you are responsible for financially;
3) opt out of receiving the service.
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***Does Medicare Pay for My Rest or Wait to Do the Next Intervention?***
No, rest time and general discussion are not a covered service per Medicare Claims Processing Manual Chapter 5, Section 20.3. However, this is part of the time we get to know you. You are able to share with us what else is going on in your life and how we can help you live better.
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***What Happens If I Have an Injury for Something Else While Being Seen?***
We are happy to screen and evaluate the new issue. If it meets your insurance’s criteria for a covered benefit, i.e.medically necessary and skilled care, we will conduct an initial evaluation and set up a specific plan of care. If it does not meet your insurance’s criteria then we will address as best as we can under your Titan Concierge agreement.
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***Do You Offer Payment Options?***
We do have payment options available for Titan Concierge such as quarterly, semi-annual and annual fees. These can be paid via check, cash or credit card.*
(* a processing fee of 3% will be assessed)​
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***What If I Only Want to Be Treated for the Issue I Have?***
That is your choice, and we can understand you wanting to just focus on the one issue.
However, your body is dependent on all of its systems.
Our years of experience, what research has shown and other patients claim is a full body system approach leads to better and faster results. We will be happy to answer your specific concerns during your evaluation and how Titan Concierge can help you. If you do not wish to proceed with care with us after that, you do not have to join the program and will be responsible per your insurance benefits for any physical therapy covered and non-covered services provided.
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***Do You Ever Just See Someone for a Specific Treatment? I.e. Dry Needling, Ultrasound, Compression, Stretching, Massage?***
Yes, and these services may be covered under Titan Concierge pending non-covered status of your condition.
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***How Often Do You Typically See Clients for Therapeutic Wellness?***
This depends on your goals and current health status. Most of our clients, however, fall into two categories of either once a week for 30 min. sessions, or once every-other-week for 1 hour sessions.
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***What If I Need/Want More Than 2 Hours of Therapeutic Care a Month?***
You can always purchase more time if you would like.
Our base plan is for 2 hours of in clinic care, along with all of the support for therapeutic wellness and your success.
However, we are able to make customized plans to meet your specific needs. Please contact Avery or Kara to discuss additional purchase options to add to your plan.
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***What Does an Annual Health Screening Consist Of?***
Your annual health screening is meant to evaluate your overall status and how you measure up for your age.
Several tests will be completed to help determine if you currently have any deficits that you may not know of. These will establish a baseline for you during the months and years to come, for us to review and assess any changes you have.
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Tests will look at your balance, strength, coordination, reaction skill, power output and daily function. Questionnaires will be used to help tease out areas of concern for a more specific assessment.
We invite you to share with us any concerns you have about your health or any changes in your overall medical or functional status at this time.
After your full assessment, you will review our findings with your therapist. You will discuss any areas of concern, and set up a plan to address these areas during the next year.
Topics you should expect to discuss are health diagnoses, exercise routine, diet/nutrition, sleep and recreational activities. This allows us to get a full picture and treat the entire you.
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***What If I Want My Staff to Be Part of Titan Concierge?***
Dr. Schroyer is trained to help your business reduce injury rates, worker compensation claims, absenteeism and presenteeism.
Contact our office to set up a time to further discuss how we can help you reduce your healthcare costs.
On average business programs have an ROI of > than 4:1.