As a valued patient at Mizuta & Associates Physical Therapy, your health and understanding of your financial responsibilities are important to us. This agreement provides important information about your financial responsibility for services rendered to you under Medicare Part B, particularly when concurrent services are provided by a home health provider under Medicare Part A.
Understanding Your Medicare Coverage
- Medicare Part A: typically covers hospital stays, care in a skilled nursing facility, hospice care, and home health care services.
- Medicare Part B: covers certain doctors' services, outpatient care, medical supplies, and preventive services, including physical therapy services provided by Mizuta & Associates.
Situation of Financial Liability
Under certain circumstances, if you receive treatment from a home health provider covered under Medicare Part A while also receiving outpatient services from us under Medicare Part B, Medicare regulations require that Medicare Part A takes precedence. This means:
- If you are admitted to a hospital during your treatment with us and, upon discharge, receive home health care services (e.g., a nurse visits your home for vitals or wound cleaning), or
- If another physical therapist, nurse, or occupational therapist visits your home for treatment,
Medicare will recoup payments made to us for your outpatient services, and the patient will be liable for charges.
Your Financial Responsibility
Should Medicare recoup payments from Mizuta & Associates for services rendered to you because you are receiving concurrent home health services under Medicare Part A, you will be responsible for the cost of our services. This responsibility is $120 per visit.
Proactive Communication
To avoid unexpected charges, we strongly encourage you to inform us immediately if any other provider (other than your designated therapist from Mizuta & Associates) enters your residence to provide treatment. This allows us to coordinate your care effectively and, if necessary, pause our services until you are discharged from home health services.
Acknowledgment and Agreement
I have read and understand the information provided in this agreement regarding my financial responsibilities under Medicare Part B when receiving concurrent services from a home health provider under Medicare Part A. I agree to inform Mizuta & Associates Physical Therapy promptly if I receive services from any other healthcare provider at my residence during my treatment period. I understand that failure to do so may result in my being financially responsible for the cost of services rendered by Mizuta & Associates Physical Therapy as described above.