Question 1

1. Do I need a prescription from my doctor?

Accepted Answer

Eminence Physical Therapy requires a prescription for "Physical Therapy Evaluation and Treatment" in order for you to receive services.  You must provide this to your  therapist prior to your first scheduled appointment. This prescription may come from your primary care physician, oncologist, surgeon, vascular physician, physician's assistant, or nurse practitioner.    If you wish to receive dry needling services, a physicians referral is mandatory prior to the initiation of this treatment intervention.   Please visit the "Patient Resources" page if you would like a prescription form to provide to your physician for completion. It may be faxed to 770-818-5878 or emailed to info@eminencept.com

Question 2

2. What is the advantage of a cash-based physical therapy practice?

Accepted Answer

With cash-based physical therapy, you and your therapist collectively decide on how many visits you will need and the frequency of visits per week. No more insurance limits on the number of visits you are allowed for physical therapy per calendar year and no more waiting on insurance approval for start of care or for additional visits to continue care. Your treatment is based on you and your progress.

Question 3

3. Will my insurance company reimburse me for physical therapy services provided by a cash-based practice?

Accepted Answer

Depending on your insurance policy, once you ﬁle a claim, you will either receive a reimbursement check from the insurance company or the cost of the appointment will be applied to your deductible. Insurance companies reimburse patients according to their own fee schedules, and each insurance company has a different rate of reimbursement for different therapy treatment codes utilized. Eminence Physical Therapy does not have control over what your insurance company reimburses.

Question 4

4. How flexible are the appointments?

Accepted Answer

Dr. Champion has the ability to arrange her appointments and schedule to be able to meet your needs and provide you with the most convenient care.

Question 5

5. What can I expect during my first visit?

Accepted Answer

During your ﬁrst visit you can expect the following:   • Your paperwork should be completed prior to your appointment (you can download it from our website - see Intake Forms).   • You will provide us with your prescription for physical therapy if your therapist advises you to do so.   • You will be seen for the initial evaluation by Dr. Champion.   • The following will be discussed:    1. Your medical history. 2. Your current problems/complaints. 3. Pain intensity, what aggravates and eases the problem. 4. How this is impacting your daily activities or your functional limitations. 5. Your goals with physical therapy. 6. Medications, tests, and procedures related to your health.   Dr. Champion will then perform the objective evaluation which may include some of the following:   1. Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inﬂammation, etc.   2. Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.   3. Muscle Testing - the therapist may check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.   4. Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reﬂexes may be assessed as well.   5. Special Tests - the therapist may perform special tests to conﬁrm/rule out the presence of additional problems.   6. Limb Volume Measurements (For Lymphedema)- the therapist will take measurements of both the affected extremity and the non-affected extremity for comparison in order to track your progress throughout your treatment   Dr. Champion will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient's input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created with input from you, your therapist, and your doctor.

Question 6

6. How long are the treatment sessions?

Accepted Answer

All cancer rehabilitation appointments are 60 minutes. Due to the complexity of lymphedema treatment, sessions are 60-90 minutes.   All sessions are one-on-one with Dr. Champion.

Question 7

7. How long will I require physical therapy services?

Accepted Answer

Your physical therapist will determine this at the time of your initial evaluation once your physical therapy plan of care (POC) has been established.   For lymphedema therapy, treatment sessions of at least 2-3 times per week are recommended for maximum effectiveness and is also dependent on the severity of your condition.

Question 8

8. What If I have Medicare or Medicaid?

Accepted Answer

Eminence Physical Therapy has no relationship with Medicare and typically cannot provide cash-based PT services for traditional Medicare beneficiaries unless the services are for wellness purposes only and not intended to treat a pathology, injury, or disability. Wellness visits are similar to personal training.    Individuals that have Medicare Advantage or Medicare Replacement Plans (HMOs, PPOs) can be serviced, however you must contact your insurance company to determine if any pre-authorization is required if you plan to submit claims for possible reimbursement.   Medicaid usually requires pre-authorization for PT services, so reimbursement cannot be guaranteed if you choose to submit claims to Medicaid.

Question 9

9. What if I need compression garments to manage my swelling?

Accepted Answer

Your therapist will assess you for the type of compression garments appropriate for your treatment. Your therapist will also measure you for your garments. You may qualify for compression garment coverage through your insurance company. Your therapist will obtain information from you to submit to a DME company to check your beneﬁts coverage for compression garments as well as for order placement.

Question 10

10. What should I wear?

Accepted Answer

You should wear loose ﬁtting clothing so you can expose the area that will be evaluated and treated. If your therapist requires more exposure in order to complete the evaluation process, your modesty will be protected and you will be draped and covered appropriately.

Question 11

11. Should a family member be present with me during any of my treatments?

Accepted Answer

It is strongly suggested that a family member or caregiver be present with you during the evaluation and for at least for 1-2 visits in the event that you require assistance for your home exercise program or for performing compression bandaging or compression garment application for your lymphedema treatment.

Question 12

12. Is my therapist licensed?

Accepted Answer

Physical therapists (PTs) are licensed by their respective states and must be licensed in order to practice. Dr. Champion is licensed by the state of Georgia.

Question 13

13. Who will see me?

Accepted Answer

Dr. Champion is the only Physical Therapist on staff and you will see her for every visit.

Question 14

14. Georgia is a direct-access physical therapy state. Why does Eminence Physical Therapy require a prescription from my doctor?

Accepted Answer

Georgia is a direct PT access state, which means a physician’s prescription is not required to initiate a  physical therapy evaluation and treatment. With direct access, if your therapist determines that you will require more than 21 calendar days or more than 8 visits of treatment after the initiation of a physical therapy plan of care, your therapist will advise you to contact your physician to obtain an appropriate referral for continuation of treatment.  Eminence Physical Therapy requires a prescription prior to treatment as often the complexity in the treatment of lymphedema and cancer diagnoses will surpass the 21 days or 8 visit time frame for treatment. Your insurance company may also require a physician’s prescription on file if you plan to file a claim for reimbursement of services provided by Eminence Physical Therapy.

Question 15

15. Can my insurance be billed for cash-based physical therapy services?

Accepted Answer

Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received “out-of-network”.  Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company.  Many patients choose to receive services out-of-network in order to see the physical therapist of their choice.  The end goal of documentation and billing is the same - getting paid. In the case of cash-based services, it is the patient who is submitting claims and waiting for reimbursement rather than the provider.

Question 16

16. The therapist for Eminence Physical Therapy is an out-of-network provider-what does this mean?

Accepted Answer

This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates.  There are MANY insurance companies, each with their own contracted rates and regulations, and Eminence Physical Therapy’s energy is best spent working with patients.  It is important to note that in-network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.

Question 17

17. Will I end up paying more for cash-based therapy?

Accepted Answer

In many cases, the out-of-pocket expenses for a course of physical therapy will actually be LESS for services provided at Eminence Physical Therapy.  In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical fee-for-service outpatient physical therapy practice in which deductibles must be met and therapy visit co-pays apply.  Eminence Physical Therapy can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service.  This allows Eminence Physical Therapy to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.

Question 18

18. How do I find out my insurance benefits for outpatient physical therapy?

Accepted Answer

Complete the Insurance Benefits Worksheet here, which will help you determine your physical therapy benefits. Keep in mind that Eminence Physical Therapy is an out-of-network provider for all insurance companies, so be sure to notify your insurance company that you want to determine your physical therapy benefits for an out-of-network provider.

Question 19

19. What steps are involved in submitting a claim to my insurance company?

Accepted Answer

The process is actually quite simple:  Eminence Physical Therapy will provide you with an invoice at the time of service if requested, and you may submit that invoice and receipt to your insurance company for reimbursement. The invoice has all of the necessary  information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.  Your insurance company may also require that you send in a medical claim form with your invoices. Please contact your insurance provider for specific details on how to submit your claims.

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