Explanation of Billing for Home Therapy Solutions

Thank you for choosing Home Therapy Solutions for your outpatient physical and occupational therapy needs. We strive to provide you with high-quality care while ensuring transparency and clarity regarding our billing practices. Below is important information regarding billing, insurance requirements, and when you can expect to receive a bill.

At Home Therapy Solutions, we bill each 15 minute therapy treatment CPT code at $90 per unit, and each evaluation code is billed at $270. These charges have been carefully determined to align with industry standards and ensure affordable and competitive pricing for our clients. Our billing rates are in line with the recommendations provided by Fair Health Consumer, a reputable resource for healthcare cost information (https://www.fairhealthconsumer.org).

• In-Home Mobile Visits for Services not covered by insurance:

  • One hour minimum for private pay mobile visits.
  • $25 travel fee if outside HTS Travel Radius
  • HTS covers Grand Forks/East Grand Forks and a 15 mile radius outside of GF/EGF
  • 40 miles outside of GF/EGF is the max radius, unless approved by Therapy Manager

• In addition to therapy treatments and evaluations, we provide additional services that are not covered by insurance. These include:

• Geriatric Case Management: $100 per hour

• Private Pay Personal Care Services in North Dakota:  Completed by CNAs/QSPs
• 1 hour or less: $30.00

• More than one hour: $28.00 Per Hour

Private Pay Services available for clients without insurance or for those that choose not to bill insurance, except for services covered by Medicare and Medicare Advantage Plans. We are required to bill Medicare for services that are skilled and medically necessary. Medicare Advantage plan requirements depend on the type of plan. Private Pay Services are available to Medicare beneficiaries if the service provided is no longer skilled and medically necessary. A Prompt Pay Discount is available for Private Pay clients that pay at time of invoice. The Prompt Pay Discount is based on the Medicare Fee Schedule. Private pay clients will be provided with a good faith estimate.

If we are in-network with your health plan, we will submit the claims to your health plan on your behalf and your health plan will send payment directly to us. If your health plan denies payment of our claims, in whole or in part, you are responsible for paying any and all unpaid amounts upon receipt of invoice.  You also agree that if any payments are sent to you despite your assignment of benefits to us, you will promptly forward the funds and explanation of benefits/payment.  

Insurances we are Credentialed with (In Network)

• Blue Cross Blue Shield of North Dakota
• Blue Cross Blue Shield of Minnesota
• Next Blue of North Dakota
• ND Workers Compensation
• Aetna for Physical Therapy
• TriCare
• Sanford Health
• Medica
• Health Partners
• ND Medicare
• MN Medicare
• ND Medicaid
• ND Medicaid Expansion
• MN Medicaid

If your insurance plan allows out-of network claims, we will bill your health plan for our services directly and await payment from your health plan. You agree that if your health plan does not honor the assignment and sends payment to you, you will promptly forward the payments to us. You further agree that if your health plan denies payment of our claims, in whole or in part, you are responsible for paying any and all unpaid amounts upon receipt of invoice.

Discounted Private Pay services are available for clients without insurance or for those who voluntarily elect not to use their health plan benefits, except for services covered by Medicare and Medicare Advantage plans. We are required to bill Medicare for services that are skilled and medically necessary. Medicare Advantage requirements vary by plan.

Private Pay services may be available to Medicare beneficiaries only when services are no longer skilled or medically necessary or are otherwise non-covered, in accordance with Medicare rules.

We offer a discounted private payment rate when payment is made at the time of invoice.   This discounted private pay rate reflects reduced administrative work and time, including the absence of insurance claim submission and prior authorization requirements. The private pay rate is available to clients without insurance or to clients who voluntarily elect not to use their health plan benefits (excluding Medicare-covered services as noted above).

If we are in-network with your health plan, our private pay rate may be less than the contracted in-network rate negotiated with your health plan.

If you elect Private Pay:

• We will not submit claims to your health plan
• We will not obtain prior authorizations
• You agree not to submit claims, invoices, or statements to your health plan for reimbursement

If you choose to pay privately and later elect to use your health plan benefits:

• Insurance-based fees and policies will apply
• Coverage may be limited or delayed due to authorization requirements or plan limitations

If you choose to switch from using an in-network insurance plan to Private Pay, the change applies only to future dates of service.   Services previously billed to insurance cannot be retroactively converted to Private Pay.  A completed and signed Request to Switch Payment Method Acknowledgment form is required before the change takes effect. Verbal requests or informal written communication are not sufficient.

If you receive a bill several weeks or months after the services were provided, it is because we process and send billing statements after payment is received from the insurance carrier. The time required for this process depends on how long it takes to receive a response from your insurance carrier. Additionally, if your insurance carrier denies the initial claim, we may initiate an appeal to secure payment for the services provided, which can further delay your billing.

• Estimated Cost of Private Pay Initial Evaluation: $216
  (1 unit evaluation / 3 units treatment)
• Estimated Cost of 1-hour Private Pay Treatment Session: $144
• Estimated Cost of 45-minute Private Pay Treatment Session: $108
• Dry Needling: $36 1-2 muscles; $72 3+ muscles

Insurance claims are billed daily to your insurance carrier. The processing time for these claims typically ranges from 30 to 60 days. However, please note that additional processing time may be required if your insurance carrier requests further information or denies the initial claim. In such cases, an appeal process may be initiated, which could further delay your billing.

Invoices are generated once insurance processing is complete and patient responsibility is determined.

For Private Pay clients, invoices are generated and issued according to the normal billing cycle, and payment is due at the time of invoice.

Please be aware that the prices listed on the billing statements are the amounts billed to your insurer. However, the actual amount you are required to pay out-of-pocket may vary. Providers are often reimbursed at rates lower than the charges. Commercial insurance clients may have negotiated rates, while Medicare and Medicaid clients have reimbursement rates determined by federal and state governments.

If you receive a bill several weeks or months after the services were provided, it is because we process and send billing statements after payment is received from the insurance carrier. The time required for this process depends on how long it takes to receive a response from your insurance carrier. Additionally, if your insurance carrier denies the initial claim, we may initiate an appeal to secure payment for the services provided, which can further delay your billing.

It is essential to familiarize yourself with the coverage, deductible amount, co-insurance and co-pay requirements of your specific insurance plan. We cannot predict which services will be covered by individual health plans. Some plans may limit payments to “usual, customary, and reasonable payment.” To obtain coverage information, please consult your employer, insurance agent, or refer to the details provided by your insurance plan. For Medicare beneficiaries, you can find information on Medicare benefits at your local Social Security office or online at https://www.medicare.gov/. 

If you have a coinsurance or deductible which has not been met, we estimate the coinsurance/deductible amounts based on the insurance information provided when insurance verification is completed. Since this is an estimate, you may have a refund or balance due. 

Home Therapy Solutions provides insurance verification as a courtesy to our clients.  Home Therapy Solutions cannot guarantee the accuracy of this information.  It is the responsibility of each client to be knowledgeable about their insurance coverage. Your insurance coverage is a contract between you and your insurance company and you are responsible for knowing the level of coverage.

Many health plans require pre-certification and sometimes predetermination of medical necessity before care is rendered. Additionally, certain services may not be covered by benefits under some insurance plans. Investigating coverage requirements and limitations can take time. It is your responsibility to understand the pre-certification requirements of your health plan. We recommend contacting your insurance company to determine the benefits and coverage specific to your plan.

Some health insurance companies have visit limits for therapy services.  Home Therapy Solutions will attempt to track visits authorized by the insurance company as a courtesy and there is no guarantee of the accuracy.  It is the clients responsibility to keep track of their visit limits. 

If an overpayment has been made, a refund will be issued immediately.  If you feel a refund is due, please contact our billing office.

If a payment is made by check that has insufficient funds, the client will be charged a returned check fee of $30. 

Payment is expected at time of invoice.  If your account is more than 14 days past due, we will begin our internal collection efforts.  If your bill is not paid within 30 days,without an established payment plan on file, your account will be sent to a collection agency.  Home Therapy Solutions is not required to obtain written authorization to disclose protected health information to a collection agency or court of law that may be necessary to collect payment for services rendered. Clients are responsible for paying the collection costs plus court costs and filing fees incurred if collection proceedings or other legal action is necessary to collect payment. 

We hope this explanation of our billing practices provides you with the necessary information. If you have any further questions or concerns, please feel free to contact us.