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Treating Osteoporosis: What works for you?

Osteoporosis & Bone Health | Last Active: Nov 3, 2023 | Replies (1084)

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@sueinmn

You mentioned "I think the restrictions may somehow vary by state though because my experience with PT in NH does not match the experience that a relative in MA has had."

Medicare rules are the same for everyone, put in place by the Federal government. The "reporting" discrepancy in PT is most likely based on the terms of your supplementary Medicare policy, which may vary by state, because that is who regulates the health insurance companies. But underneath it all, the policy must comply with Medicare rules, which covers PT policies. It is an enormous, complex web, and part of what contributes to the high cost of our insurance and medical care. Medical practices and facilities have entire departments that do nothing except deal with Medicare and private insurance coverage and the complexities of coding each segment of care so that it gets paid for.

But if there is no progress, or the patient is deemed "non-compliant" (like failing to do the at-home exercises, or failing to show up for appointments) Medicare payments will stop.
Sue

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Replies to "You mentioned "I think the restrictions may somehow vary by state though because my experience with..."

@sueinmn That was what was confusing to me, that being a federal program the states might have different rules for administering it. When I was much younger I actually worked in Blue Cross in Boston, within the Medicare administration department so I am somewhat familiar - things haven't changed that much.

When I went for PT, and I went a number of times for different things, at least monthly I had to fill out a form that was sent to Medicare showing my progress. It was difficult to fill out because not remembering what I had said the prior month I sometimes checked boxes that would indicate I was worse than I had been the prior month! Judging your ability and your pain is very subjective. I went to more than one PT place too and all three required that.

My relative in MA never had any of that! He went for quite a while after a hip replacement too so it just seemed strange. I realize the basic rules cannot vary but perhaps the administration of them can?
JK