MedExPRO Referral-Reimbursement Readiness Checklist
In this MES Podcast episode, Dr. Mike breaks down what it means for medical exercise professionals to be both "Referral Ready" and "Reimbursement Ready." Since he began teaching the Medical Exercise Specialist program in 1994, the healthcare system has changed dramatically. It is no longer a simple handoff from physical therapy; clients now need specific documentation for insurance carriers, and medical professionals are actively seeking qualified fitness professionals to refer their patients to. Dr. Mike walks listeners through a comprehensive, step-by-step checklist to help assess whether their practice is fully prepared to handle these medical referrals and assist clients with insurance reimbursement.
Key Takeaways & Checklist Highlights
1. What is "Referral Ready"? Being referral ready means having professional, step-by-step systems in place to accept and process clients coming from medical professionals.
• Medical Referral Requirements: You must obtain a written referral from a licensed medical provider (MD, DO, Chiropractor, or Naturopath) that includes a medical diagnosis, an ICD-10 code, and confirms the client's discharge from formal medical treatment. The referral should specifically request medical exercise training or functional conditioning, not physical therapy.
• Intake & Assessment Systems: Standardized intake forms must document the diagnosis, ICD-10 code, and functional limitations. Assessments and programming must be framed around functional capacity and evidence-based practices rather than general fitness goals.
• Provider Communication: You must establish a consistent, professional communication loop with the referring provider, including an initial intake summary and progress reports at defined intervals using appropriate medical terminology.
2. What is "Reimbursement Ready"? Being reimbursement ready means you can provide clients with the precise documentation they need to seek reimbursement from their insurance carriers. You are not billing the insurance directly or providing medical treatment; rather, you are supplying the paperwork so the client can submit the claims themselves.
• Reimbursement Clarity: Clients must clearly understand that there is no guarantee of insurance reimbursement and that they are responsible for submitting the paperwork.
• Documentation Standards: Every session must be documented with the date, duration, services provided, and functional focus tied to the client's diagnosis.
• The Client-Ready Packet: You must provide clients with "super bills" that specifically outline session activities and charges using CPT codes, alongside necessary progress reports and discharge summaries.
• Professional Confidence: Professionals must confidently explain their scope of practice, answer client questions regarding their exercise program, and manage reimbursement conversations without overstepping boundaries.
Featured Resources & Call to Action
• Download the Checklist: Listeners can download the Referral and Reimbursement Ready Checklist at: https://www.postrehab.com/offers/J3ki22Wk
• Join the MES Enterprise Cohort: If you couldn't answer "yes" to every item on the checklist, consider joining the upcoming MES Enterprise Cohort.
This 90-day program is designed to make your practice fully referral and reimbursement ready through masterclasses and unlimited one-on-one coaching.
The cohort begins on February 28th and only has 6 slots remaining.
• Contact Dr. Mike: For questions about the checklist or the cohort, email Dr. Mike at drmikepostrehab.com.
Future Outlook: The need for medical exercise training will grow exponentially over the next 20 years due to the aging baby boomer population, the chronic health crisis, and ongoing changes in insurance reimbursement. Ensure your practice is ready to take advantage of these opportunities!
Download the checklist at: https://www.postrehab.com/offers/J3ki22Wk