MET 101 Tip #40: Avoid the Billing Trap—Protect Yourself and Your Practice
In Tip #40 of the MET 101 series, Dr. Mike dives into one of the most misunderstood and risky areas in medical exercise training: billing through a medical doctor (MD) or physical therapist (RPT) for services performed by a Medical Exercise Professional.
Dr. Mike warns MedExPROs about the "slippery slope" of indirect billing—a practice where a medical professional bills insurance for services that were actually delivered by a Medical Exercise Specialist, but without direct supervision. This isn’t a gray area—it’s insurance fraud, and it can jeopardize everyone involved, including your career. Dr. Mike shares examples such as MES professionals seeing clients at home or in a clinic while the doctor is absent, yet the provider still bills for the session. That’s a clear violation.
Instead, Dr. Mike explains the only legitimate way for a medical provider to bill for your services: you must be an employee, and medical professional must provide direct, on-premises supervision. If those two conditions aren’t met, insurance billing is off the table. In cash-pay scenarios, such as post-rehab exercise programming that is not billed to insurance, a fair and ethical 50/50 revenue split with the facility is suggested.
He also cautions MedExPROs to stay in their lane when it comes to cardiac rehab. These clients require telemetry, emergency equipment, and clinical supervision far beyond the MES or PRCS scope. Medical exercise training is not cardiac rehab—and should never be presented as such.
💡 MedExPRO Takeaway:
Be crystal clear about your role, your billing relationship, and your legal boundaries. Don’t put your reputation or your future at risk by participating in unethical billing practices. Educate yourself, protect yourself, and work within your scope.
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