• Medicare Part B Patient Acknowledgement

    For patients with Original/Traditional Medicare
    Medicare Part B Patient Acknowledgement

  •  

    Understanding Medicare Coverage 

    At Mizuta PT, we want to ensure you clearly understand your coverage and financial responsibilities under Medicare Part B, especially if you also receive care from a home health provider under Medicare Part A. 

    Medicare Part A generally covers hospital stays, skilled nursing facilities, hospice care, and home health services. 

    Medicare Part B covers outpatient care, including physical therapy services provided by Mizuta & Associates.  

     

    When Financial Liability May Apply 

    If you are receiving services covered under Medicare Part A (such as home health nursing or therapy visits) while also receiving outpatient physical therapy from us under Medicare Part B, Medicare regulations require that Part A takes precedence.

    This means: If you are discharged from the hospital and begin receiving home health visits (for example, nursing, wound care, or therapy in your home),

    or 

    If another physical therapist, nurse, or occupational therapist visits your home for treatment,  then Medicare will recoup payments previously made to us for outpatient therapy. In those cases, you would be responsible for those visits. 

    Patient Responsibility: If Medicare recoups payments due to overlapping home health services, you will be responsible for the visit charge of $130 per session. 

     

    Communication is Key

    To help prevent unexpected charges, please notify us immediately if any provider (other than your Mizuta therapist) begins providing care in your home. This allows us to coordinate care and, if needed, pause outpatient services until home health care is completed.  

  •  Seconday or Supplemental Coverage

    Medicare typically pays 80% of approved charges after your annual deductible is met. The remaining 20% coinsurance ($23 per visit) is your responsibility unless a secondary or supplemental plan covers it.

    Some secondary plans do not cover the Medicare deductible but will cover the 20% once the deductible is met. Additionally, some secondary insurances have their own deductible that must be met before they begin paying their portion. Because coverage varies by plan, you are responsible for knowing your benefits and how your plan coordinates with Medicare. 

  • It’s important that your benefits are properly coordinated with Medicare so your claims automatically forward (“crossover”) to your secondary plan. This helps prevent delays and avoidable denials. 

     

    Why This Matters 

    We frequently see secondary plans deny payment for reasons like “no claim on file,” “claim not received,” or other administrative issues when we must send the claim manually (i.e., when Medicare crossover is not set up). When crossover is active, Medicare transmits your claim directly to your secondary insurer and these denials are uncommon. If crossover is not set up, we must submit the secondary claim manually—which requires batching, printing, scanning, and mailing a full billing packet. 

     

    Our Courtesy & Your Responsibility 

    • We will manually submit your secondary claims as a one time courtesy if needed. 
    • If the secondary does not pay within 45 days of that submission, you will be responsible for the Medicare 20% coinsurance, which is $23 per unpaid visit.  
    • We will email you the billing packet we mailed to your secondary so you can follow up directly with your secondary insurance for reimbursement. 

     

    How to Ensure Medicare Crossover Is Set Up 

    • Contact your secondary insurer (e.g., AARP, Blue Cross, Cigna, etc.). 
    • Ask them to submit a “Coordination of Benefits (COB)” update to Medicare. 
    • 3. Verify crossover status by calling Medicare’s Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627.  

    *For more information, visit: CMS Coordination of Benefits Overview (cms.gov) 

  • Acknowledgment and Agreement

    By signing below, you attest:

    I have read and understand that Medicare Part A takes precedence over Part B when home health services are active and that I will be responsible for outpatient visits with Mizuta PT ($130 per session) if Medicare recoups payments.

  • Acknowledgment and Agreement

    By signing below, you attest:

    I have read and understand that Medicare Part A takes precedence over Part B when home health services are active and that I will be responsible for outpatient visits with Mizuta PT ($130 per session) if Medicare recoups payments.

    I have read and understand it is my responsibility to ensure Medicare crossover to my secondary insurance. I understand that if crossover is NOT set up, Mizuta & Associates will submit secondary claims once manually and that unpaid claims after 45 days are my responsibility for the 20% Medicare coinsurance ($23 per visit). 

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