Does Medicare require you to have a physical office to see clients in your private psychotherapy practice?
I’ve seen this question posted several times in forums since the pandemic began. I get asked this question often, so here’s the long and short of it.
Short answer first: YES. CMS (https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance?redirect=/home/regsguidance.asp) makes the rules and regulations and they apply nationwide.
Here’s the long answer I recently wrote to someone (I’ve edited that response and added some minor details and links for this post):
Regular Medicare requires us to have a brick-n-mortar practice address/office that is not your home address. You have to be able to see Medicare recipients in person and your home is not acceptable (and after the PHE ends, you will be required to see them in person periodically; how often will depend on how the rules change by then). These are CMS rules and regulations that apply nationwide.
Your billing, correspondence, and notification addresses can be your home address.
If you decide not to get a real office in your telehealth-only practice and you decide to see Medicare recipients who can pay privately (no reimbursement from Medicare), you will need to “opt-out” of Medicare. With your license (LCSW), you are already an “eligible provider,” even if you have not “enrolled,” therefore, you are required to follow Medicare guidelines for Medicare recipients, unless you officially “opt-out.” (https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Manage-Your-Enrollment)
By the way, for seeing Medicare folks, following the guidelines includes charging only what Medicare will reimburse (and that is dependent on which jurisdiction you are in). (https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/contact_list.pdf)
The question I received recently also indicated the clinician might apply to commercial insurance panels. Here’s information related to that and Medicare:
Some commercial insurance companies require you to have a brick-n-mortar office, but it might be hard to figure out if the panel you are applying to requires it.
I would call provider relations and ask before going through the hassle and/or cost of credentialing (but know that information from them can be inaccurate and also remember they can and do change their rules even after you are contracted).
That commercial insurance you are interested in may even have a Medicare product, so without a brick-n-mortar, you’d either a) be excluded from their Medicare folks, or b) to be eligible to see their Medicare recipients, you’d have to enroll with regular Medicare first.
I enrolled in Medicare and contracted with several insurance companies from the start of my practice, then this year took myself off all commercial panels.
Medicare has been my bread-n-butter since the beginning (and my favorite population), however, if I ever reopen my practice (closed this summer due to family caregiving), I will opt-out of Medicare (much to my own surprise) because the risks have become personally unacceptable. It is a personal and business model decision you should make with as much information as possible.
The person who asked me recently didn’t ask about private pay only, but here’s a tip:
You can make more money hourly with private pay only (don’t offer superbills for clients to get reimbursed). You can avoid the risk of audits and clawbacks which are very real, have less stress about several everyday things related to insurance contracts, reimbursement and documentation requirements, and have greater peace of mind in the short and long runs by offering private pay only (no insurance reimbursement to you or client).
You just have to understand how to find clients.
Offering “telehealth only” makes this doable since you can see clients across the state you are licensed in (and potentially more states with laws and regulations changing due to pandemic demands) making it a more open field to build a referral network for clients who can afford private pay. The biggest concerns are the clinical implications which I’ve written about in a recent thread on the NASW forum.
For anyone with questions, I’m happy to consult further regarding the pros and cons of insurance contracting and enrolling in Medicare. The cost is $90/hr whether it’s online video, phone, or detailed email responses after we’ve had the first consultation.
If you are looking to start your private psychotherapy practice, check out the guide I wrote. It’s guaranteed to answer a zillion questions (okay, not a zillion but lots).
Get the guide on Amazon: